# When you consume lamotrigine option, clonazepam and SSRI?



## hopefuluk2 (Aug 20, 2015)

Hello everyone,

Lamotrigine does not seem to be working for everyone. In fact, it seems to be making some people worse according to many views at this website. When you are so desperate for a solution and you have consumed the lamotrigine + SSRI option, does not clonazepam become the best option? So many of those who are here would say no and it has bad withdrawal symptoms but the answer would be is that when you want to take it, you are trying to think of NOW, the few years that this medication could help you. I would not mind if it worked for 7 years and cleared my brain fog and had to quit afterwards. It is better for me to do this than to struggle for the next seven years. My next plan would be to try to SSRI and Lamotrigine but if they do not work. I want to take SSRI and clonazepam . Diazpem worked well for me before and it cleared my brain fog/blank mind. It made me depressed though so if I take clonazepam, I will add SSRI to it. Again, I know that my brain will build tolerance but when you are desperate for a solution, it does not matter what will happen after seven years. What really matters is the NOW. There might be medication for DP after seven years? Would like to hear your opinions.


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## TDX (Jul 12, 2014)

I've collected some data from the old board. One result was that 30% of patients experience a significant reduction in depersonalization symptoms with Clonazepam or Clonazepam + SSRI. In my opinion a clinical trial of Clonazepam as a treatment of depersonalization disorder is warranted.

Sometimes people combine Clonazepam with an SSRI and Lamotrigine. This has been called the "London-Mix", because the Depersonalization Research Unit used this combination.


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## hopefuluk2 (Aug 20, 2015)

I have been following your record of medications TDX and I know that you are going to take lamotrigine soon but may I know why you have not tried Clonazepam yet? Is it on your list of medications?


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## TDX (Jul 12, 2014)

I would take Clonazepam, but I have no anxiety, so I will most likely not get it. Getting Lamotrigine was difficult enough. 2.5 days until I get it.

In my opinion it should only be used when other medications like Clomipramine, Lamotrigine, opioid-antagonists and atypical antipsychotics fail, because of the danger of addiction. If it works addiction might not be a problem, because you will take it for the remainder of your life anyway. Some users like Dreamer and comfortably numb have been taking Clonazepam for years or even decades without a decline of the anti-depersonalisative effect.


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## hopefuluk2 (Aug 20, 2015)

TDX said:


> Some users like Dreamer and comfortably numb have been taking Clonazepam for years or even decades without a decline of the anti-depersonalisative effect.


Why continue to take the medication if it is not helping them then?


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## hopefuluk2 (Aug 20, 2015)

TDX said:


> I would take Clonazepam, but I have no anxiety, so I will most likely not get it. Getting Lamotrigine was difficult enough. 2.5 days until I get it.


I guess clonazepam and benzos help with the blank mind. Diazepem removed my blank mind completely for a a two weeks but after stopping it, it came back


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## TDX (Jul 12, 2014)

> Why continue to take the medication if it is not helping them then?


It helps them. This is why they are taking it. Dreamer experienced a substantial improvement that prevented her from commiting suicide. Comfortably numb got a full remission from his depersonalization symptoms.



> I guess clonazepam and benzos help with the blank mind. Diazepem removed my blank mind completely for a a two weeks but after stopping it, it came back


I never heard that it works selectively against the blank mind. if it does for your, then it's good.


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## TDX (Jul 12, 2014)

> In 7 years' time, we'll probably have widespread availability of selective KOR antagonists. Hopefully that'll be the case in a few years.


I will try to get Nalmefene or Buprenorphine before, if Lamotrigine does not work. I would have waited for 1 year, as expected before the ALKS-5461-trial-failure, but another 7 years exceed my patience.

I really hope that the Lamotrigine helps. According to the DPRU (see their book on the CBT-approach) the success rate is 50% for Lamotrigine alone and 70% for Lamotrigine + SSRI. I do not know if I can believe this. It's my impression that at least on this forum the response rate is much lower. But this could be due to the people on this forum not being representative, for example because of a higher proportion being drug induced.

Unlike many other people I also do not experience a worsening of my symptoms while on antipsychotics (have taken Quetiapine, Aripiprazole, Amisulprid and Clozapine). This is in accordance with the NMDA-antagonist model, where antipsychotics don't make the symptoms worse either. My symptoms are also not drug induced. Maybe this increases my chances to respond to Lamotrigine.


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## TDX (Jul 12, 2014)

> Surely these lamotrigine figures must come from unpublished data/estimates based on their clinical experience?


I don't know. In their book they don't say where this numbers come from. Maybe I could ask them per e-mail. But wait, you said they don't respond to mails. Damn...



> If such numbers did turn out to be representative then (augmented) lamotrigine would definitely deserve its place as the current first-line treatment.


My intention is to try Lamotrigine first without an SSRI, because there is no known neurobiological reason why this combination should work better. If it does not work I will add Vortioxetine.

I don't know what to do with the Clozapine. It allows me to sleep 10 to 12 hours a day and so the time flows considerably faster. Thus it increases the "quality" of my so-called "life". As the Lamotrigine-Clozapine-Combo is an experimental treatment of treatment-resistant schizophrenia I conclude that both can be combined.



> A lot of people who responded very well to pharmacological solutions probably left and never returned.


Or they never registered.


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## hopefuluk2 (Aug 20, 2015)

Have you tried taking clonazepam? Many people who got their DP from weed panic attack seemed to have had good luck with clonazepam for a few years at least?


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## hopefuluk2 (Aug 20, 2015)

I have taken diazepam and it worked amazingly well for me. It made me depressed though. Once I stopped taking it, DP came back severely. I am aware of Benzo withdrawal symptoms and read scary things at this website. I have not read many positive reviews of lamotrigine at this website but everyone who used clonazepam seemed to have success with it for a few years. This is what matters to me is to have a medication that gives me relief for a few years so that I can start well with my career after finishing my PhD. It does not really matter what will happen after five or six years. There might be some medication for DP out by then. Thanks for the advice guys! Much appreciated


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## Gregarrio (Aug 28, 2008)

Hello,

I wanted to comment on this thread as someone who is doing much better with the lamotrigine, SSRI, benzo combo.

I'm taking 300mg lamotrigine, 0.5mg clonazepam, and 5mg escitilopram. I have a good psych doc who eventually let me put my cocktail together myself, as long as he didn't see it as dangerous. I've been taking these three drugs at slightly varying doses for over five years with marked improvement in out-of-body and emotional numbness symptom. For me, the hardest part is dealing with cognitive difficulties. There is fluctuation, though. And that always continues to give me hope for full remission.

During the five or so years with this cocktail (maybe longer, I can't remember), I took about a year long break from the clonazepam simply because I ran out one time and didn't notice any significant withdrawal symptoms. I also thought it would be a good time to "reset" any tolerance. In November 2014, I moved up from 200mg lamotrigine to 300mg, added the 0.5.mg clonazepam back and dropped my escitilopram from 10mg to 5mg. I seem to remember reading that clonazepam has anticonvulsant properties that diazepam doesn't. And, for myself, diazepam doesn't reduce symptoms as much as it reduces anxiety around the symptoms. Clonazepam actually seems to clear things up a bit. This time around though I seem to have more of a dependence on it. I am noticeably foggier if I forget to take it.

I've had significant improvement since making this adjustment, but there were also several lifestyle changes that may have contributed to symptom relief as well. Part of that involves coping with symptoms and not obsessively researching them. That's why I had to specifically stay away from this site. For me, I've come to see DP as having a very subjective quality to it. It's a catch 22 though because researching is how I've found out how to balance addressing the condition with medication and lifestyle choices, while also not letting it be a life determining condition.

It's exciting to see discussions of new medications potentially having a better effect (something about opiod receptors). It makes me wonder if and how I'd switch if this became more successful with others, especially with the cognitive symptoms which I struggle with most.

Best,

Greg


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## sydneyarnce (Dec 2, 2015)

I have clonazepam prescribed to me and I take a bit if I feel anxious and I feel like it SORT of lifts the brain fog... 
To further put that to the test, what dosage and how regularly should I take it?


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## endritk2 (Apr 18, 2015)

sydneyarnce said:


> I have clonazepam prescribed to me and I take a bit if I feel anxious and I feel like it SORT of lifts the brain fog...
> To further put that to the test, what dosage and how regularly should I take it?


You could try Lyrica (Pregabalin) for GAD in studies Pregabalin 450mg has been shown to be just as effective as relieving anxiety in patients as Xanax (Alprazolam) who were taking 1.5mg however I would still recommend you keeping your Clonazepam prescription and using 0.5mg when the circumstance arises. Hopefully the Pregabalin will level out your anxiety so you use Clonazepam less.

If you don't respond well to Lyrica for whatever reason you can try Lyrica's older sister Nuerontin (Gabapentin)


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## endritk2 (Apr 18, 2015)

Gregarrio said:


> Hello,
> 
> I wanted to comment on this thread as someone who is doing much better with the lamotrigine, SSRI, benzo combo.
> 
> ...


You could try switching from Escitalopram to Vortioxetine (both made by same company) which has shown cognitive improvements in adults with MDD.

Although Escitalopram has approval for Major Depression and Generalized Anxiety Disorder and Vortioxetine only has approval for Major Depression, however many people report it helping their anxiety too.

It's good to see that you're on 300mg of Lamotrigine as the therapeutic dose is 200mg+

As for Clonazepam, it is a long lasting benzo which is often prescribed for withdrawal from shorter lasting benzos like Alprazolam. I see many people who take either Pregabalin or Gabapentin for anxiety and they report cutting down the use of their benzo, so you could try adding either one of those drugs to your cocktail and see if it helps with your anxiety to the extent that you will only use Clonazepam in situations where you need to desperately and immediately squash a bad anxiety episode. I would say that Pregabalin or Gabapentin work to reduce the frequency of the anxiety episodes, however they can still arise.


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## endritk2 (Apr 18, 2015)

TDX said:


> I would take Clonazepam, but I have no anxiety, so I will most likely not get it. Getting Lamotrigine was difficult enough. 2.5 days until I get it.
> 
> In my opinion it should only be used when other medications like Clomipramine, Lamotrigine, opioid-antagonists and atypical antipsychotics fail, because of the danger of addiction. If it works addiction might not be a problem, because you will take it for the remainder of your life anyway. Some users like Dreamer and comfortably numb have been taking Clonazepam for years or even decades without a decline of the anti-depersonalisative effect.


There is a difference between addiction and dependence. I received my Clonazepam prescription when the unit contacted my GP with advice on medication, they specifically told him to prescribe me Clonazepam and then my GP said something about Mirtazapine but I did not take it because of the weight gain side effect.

Generally doctors are reluctant to prescribe the older generation of antidepressants like Clomipramine. However, there is an alternative

Clomipramine has a 1:1 serotonin:norpinephrine ratio along with an antihistamine effect you can try Fetzima (Levomilnacipran) which is = 1:2 serotonin:norpinephrine ratio Fetzima is a new antidepressant.

However because Fetzima has a higher affinity for norpinephrine some people have documented an increase in anxiety. You could still try this as you say you have no anxiety.

Another alternative is a drug called Milnacipran which has a 1:1 serotonin:norpinephrine ratio however it is weirdly only approved for pain by the FDA but some European countries and Japan use it as an antidepressant.

In a study it says

'The improvement of depressive symptoms was comparable between the high-dose milnacipran group and the paroxetine 40 mg/day group. Retrospective assessment revealed that patients with higher HAM-D scores on admission were more likely to be given milnacipran at a dose of 150 mg/day. These findings suggest that patients with mild depression and low HAM-D scores on admission could be sufficiently treated with milnacipran at the standard-dose (50 mg/day to 100 mg/day), while patients suffering from moderate to severe symptoms demonstrated by higher HAM-D scores might need an increase in dosage of milnacipran up to 150 mg/day to improve their symptoms. This suggests that if a patient responds poorly to the standard-dose milnacipran treatment, it may be helpful to increase the dose up to 150 mg/day while assessing patient responses.'

So if you do decide to take this alternative a starting dose would be between 50-100mg a day and then you could increase it to 150mg if need be.

As for the antihistamine most anti psychotics have an antihistamine effect.

Also you mention cognitive problems you could talk to your doctor about trying a new antidepressant Brintellix which is marketed for cognitive problems


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## tikobird (Feb 26, 2008)

Clonazepam is another Benzodiazepine that most psychiatrists and doctors don't want people on now. They've done studies that long term use affects memory and can cause dementia in the over 60 group. Benzos are very addictive and also cause dependency. They work on the central nervous system to calm it but are meant for short-term use. I'd say maybe a month or so is recommended. My current psychiatrist wants me to go off of Clonazepam gradually. I've been on them for decades which was suggested for anxiety a long time ago. I wish I'd never listened to him and used an alternative way to calm the anxiety. There are supplements, counselors and mindful meditation being used to work on anxiety. Most people want the easy fix of these addictive benzodiazepines. If you can find out when and why DP happens you can go to what your thoughts and feelings were at the time. I'm currently doing EMDR with a therapist who is very familiar with all aspects of DP.


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