Q:  Feeling Jumpy & Lamictal

my therapist put me on lamictal on top of my wellbutrin in the hopes it would alleviate some of the depression i still have.  i have some family history of bipolar disorder, however i have never had a full blown maniac episode.  i suffer mostly from depression.  the lamictal (25mg) I have only been on for three days, but it is making me feel anxious, jumpy and actually more depressed.  i cant seem to get my meds right.  i have been on all the SSRIs with little effect...wellbutrin has been the best but I went on it for the anti-smoking effect.  canm lamictal make me feel jumpy. should i stop taking it?  can you suggest another course of treatment? 

 

Dear Ms. C' -- 
Sorry to be arriving late with this answer.  Worse yet, the answer is pretty weak, along the lines of "I don't know", and I'm afraid no one does, really.  There are at least two separate questions here. 

First, can lamotrigine all by itself cause "feeling jumpy"?  The answer is "I think so, but I'm not sure".  The big research studies on lamotrigine suggest that answer is no, at least when you compare two large groups of patients, one on lamotrigine, one on placebo.  There is no difference in how many patients experience anything like overactivation, jumpiness, anxiety, etc.  But might there have been a few such people, just not enough to make a statistical difference between the groups?  After all, these are relatively common symptoms, so that there were probably some people getting them in the placebo group too, which could obscure at least slightly any true reaction like this to lamotrigine.  I think I've seen a few patients who got something like this on lamotrigine but since it can occur without the medication (given what we're treating) I'm still not sure.  But I have taken some people off the medication out of concern about this, and a few of them seemed to be better for having stopped it. 

Second, can this problem (if it exists) be worse if lamotrigine is combined with Wellbutrin?  The short answer is rather obvious:  we should assume so, until we have some reason to think otherwise.  I actually try not to start lamotrigine with an antidepressant on board just so I don't have to worry about this.  But of course that gets tricky when the antidepressant is clearly working and tapering it off, before having tapered up lamotrigine (and you know how slow that is).  

As for another course of treatment, I always turn to my routine list of mood stabilizers, looking for any arrangements that can have antidepressant effects as well as mood stabilizer effects.  Lithium is a candidate there if used cautiously.  Some people think that fish oil may also have a role here.  I make sure my patients are aware of the data on omega-3 fatty acids, at least.  And then there's exercise... (here's my essay on that, "not the usual rap").  Good luck with figuring this out. 

Dr. Phelps

Published April 2005