Hello, I take 200mg Lamictal, 45mg Mirtazapine and a very low dose of Klonopin. I have severe anxiety and “ treatment resistant “ depression. Are there any suggestions on what combination might be more helpful ? My anxiety is so high that it’s difficult to even get to a dr. appointment. I’d appreciate any feedback on what others have found helpful. Thank you
Lamictal and additional medications?
Question posted by emcs on 3 Sep 2024
Last updated on 20 September 2024
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3 Answers
emcs
11 Sep 2024
Thank you, Wildcat. I guess you were very lucky to find a good online NP. How did you go about researching details for a good one? Previously, I didn’t have any luck. I don’t know if it’s acceptable to put the name on here or how to contact you privately. All I’m certain of is that the past few days have been extremely difficult and there’s no one to get help from. If you have any suggestions, I would put my email for you to see and perhaps you could provide more details. Your help is greatly appreciated.
WildcatVet
12 Sep 2024
I'm sorry, I couldn't get back to you sooner.
Yeah, I've been extremely lucky when it comes to finding providers. Now that I'm California for the time being it's not so easy. Hard to believe that in L.A. it's much harder to find anyone who takes my insurance, doesn't charge $$$$$, and isn't booked for the next 6 months.
Are you in the U.S.? You could try ZocDoc online which is where I found my GP who got me a referral to a really good guy. It can narrow it down to providers in your area or online. It also gives you bios and patient reviews, insurance info, and usually have a fairly good waiting time for an appointment,
I'm hoping you have gotten some help and are weathering this storm okay. Do you gave any support from family/friends? It's important to be able to talk freely without judgement. How about a rabbi/priest/pastor? They'd likely know about other resources in your area.
Take care and try to get through each day... day by day as they say.
emcs
19 Sep 2024
Hi WildCat, sorry for my delay in replying, I’ve been quite sick. Yes, hard to believe in LA it’s so difficult to find someone. Have you had any luck or would your regular one in NY be of help?
I haven’t found anyone to help my situation either. What do you think about my telling NP to wean me off the Mirtazapine, which I think is causing dry eye, skin problems, uncomfortable sweating, to something else? What would be some good suggestions you feel I could pose to her? I really appreciate anything you could add. You’re a fantastic help and I really hope you’ve worked something out in LA. Thanks so much!
WildcatVet
19 Sep 2024
Are you taking the mirtazapine as an antidepressant/anxiolytic or for sleep? It's used off-label to treat depression, GAD, SAD, sometimes OCD, and anxiety. From the user reviews it seems to be a little better than 50% of users reporting a positive experience.
Being treatment resistant I assume you've been through the SSRI and SNRI medications (Lexapro, Paxil, Effexor etc.). Wellbutrin? How about adding an antipsychotic like Abilify or Rexulti as a booster to your other medication. Don't let that scare you... you're not psychotic!
I was very lucky in that my NY people wouldn't discharge me until I could verify that I was seeing a psychiatrist here. For 3 months they continued my therapy by Zoom... and as a bonus continued to send me free samples of my two very expensive medications.
Are you in the US? I don't remember if I've mentioned it but the online site called ZocDoc has a wealth of information and can find providers in your area (if there are any). It includes a bio of the doctor, education. availability, insurance accepted, and patient reviews. Most work with telehealth programs but you'd probably have to do at least one or two office visits first?
That's about all I can think of for now. Sorry for all the questions!
emcs
21 Sep 2024
Happy you found providers in LA! I’ve checked ZocDoc, no one in my area! It’s important in New England to even find a PCP. Mine is against any psych meds so is of no help. Still no callback from my NP after calling many times. I know some of the anxiety is accentuated by COPD but had it way before that recent diagnosis. Yes, I’ve been on every antidepressant with no luck and I know NP won’t want to D/C it. I’ll have to try to get her to try one of the meds you suggested although I’ve previously asked about Cymbalta & Abilify. I think it sounds reasonable. You’re taking one, just without Mirtizapine plus Lamictal. How much Lamictal is used daily given is used, in addition to what I’m on…200mg/day? You don’t think I’ll get her to approve Buspar & she refuses to increase Klonopin. I’m sorry for bothering you again, WC, I just feel like I can’t take much more of the anxiety.
And yes, I do have a couple of people to talk with but they’re at a loss for what to say. I’m so bad that I started smoking again which is the worst for COPD but it’s my only coping mechanism yet causing more breathing issues. I just don’t know what to do if I can’t get NP to get back to me Monday and there’s no choice in this area. I appreciate whatever you might add and can’t thank you enough for all your support.
jammark
5 Sep 2024
I also have severe anxiety, panic disorder and loneliness. These things have plagued me all of my life. Needless to say, I have tried the vast majority of medications including antidepressants. I am antidepressant resistant in the sense that I cannot tolerate the side effects which far outweigh any benefits for me. After decades of trying out so many medications and medication combinations, I have found that Klonopin AKA clonazepam, 1 mg three times a day works beautifully for me, and the best that I've ever tried. An added bonus is that it is a single drug without the need for me personally to add any other mental health drugs. That being said, I should also mention that I am on tramadol for fibromyalgia, which I only mentioned since it is a drug that acts on the CNS just as anxiolytics do. The max dose of Klonopin is 4 mg a day, but my doctor will not prescribe that high.
No big deal for me since 3 mg spread out evenly in three doses daily keeps me anxiety under control better than anything. And make sure that your sleep quality is good as well, and also that you are engaging in exercise or activity on a regular basis weekly.
emcs
6 Sep 2024
I apologize, Janmark I didn’t see your reply. I’m glad the Klonopin helps you so much. Right now, I’m not getting good sleep or any exercise. I know I need to really out an effort into those things. I know it helps and I’ve just been unable to do it.
I appreciate your reply and will take your suggestions.
jammark
6 Sep 2024
No problem. I just wrote that yesterday, I think. Hey, I was having difficulty getting a full night's sleep. I didn't want to use yet another prescription drug, so I turned to melatonin supplementation, a natural hormone our bodies produce, for the first time. I started at 3 mg 30-45 minutes before bedtime. Eventually, I found that 9 mg (3 - 3mg caps) 45 minutes before bedtime works wonders for me. Now, I get 8, 9 and sometimes even 10 hours of sleep a night. I used to be lucky to get 6-7. My sweet spot is at least 8 hours minimum. It has made all the difference in the world for me. I have more energy, and even less pain from my fibromyalgia. I'm betting you have already tried melatonin, but just in case I wanted to share my experience with you. I don't wake up with a 'sleep hangover' either like some prescription drugs. Best of luck, my friend. Hugs!
emcs
8 Sep 2024
I’m glad you’re getting some good rest with the melatonin. I sleep but sometimes it’s extremely late. I have taken melatonin in the past though.
Thank you for your reply and I hope you continue getting a good night’s sleep!
WildcatVet
3 Sep 2024
Hi, emcs!
Unfortunately, there is no medication or combination of meds that will be effective for everyone... what works for me may not work for you. What works for you may not work for me. Everybody responds differently to medications so it hard to say try this or that especially not knowing your history and what medications you've tried.
The Lamictal is a very good mood stabilizer for starters. Personally, I'd ditch the mirtazapine unless you need it for sleep. Replace it with a good antidepressant/anxiolytic like Lexapro, Zoloft, Paxil, etc. You could also try buspirone which controls my anxiety attacks. An atypical antidepressant like mirtazapine or Wellbutrin could be added Next, you could consider a booster antipsychotic like Rexulti, Abilify or Vraylar.
I have TRD with PTSD and anxiety disorders. I'm also bipolar. My "cocktail" is lamotrigine 200mg BID, buspirone 30mg BID (BuSpar), bupropion 450mg OD (Wellbutrin), and cariprazine 6mg OD (Vraylar). I've never used any benzodiazepine like Klonopin or Ativan.
I hope this gives you something you can think about and talk to your doctor with your own ideas..
emcs
4 Sep 2024
Thank you, Wildcat. I’ve been on Mirtizapine for a number of years..15mg daytime and 35mg at night. It doesn’t help my sleep at all, in fact I don’t sleep until ridiculous hours. I’m meeting with my NP tomorrow and can ask her about changing it. Are the withdrawals difficult that you know of? I have been on Zoloft, didn’t help as well as Paxil…they were all in addition to the Mirtizapine. I certainly need something for anxiety as TS taken over my life! I really appreciate your thoughts and will eat you know what occurs tomorrow.
If you have any idea about how bad the discontinuation of mirtizapine is, I’d appreciate your sharing. Again, thank you so much. I really need help!
WildcatVet
4 Sep 2024
If you decide to stop the mirtazapine ask the NP to recommend a tapering dose schedule. Many people can stop right away but to be safe use the schedule. If you reduce your dosage gradually you shouldn’t have much of any problem.
Yes, do post an update, okay?
emcs
4 Sep 2024
Thank you, WildcatVet. I will let you know and very much appreciate Al the information you’ve provided. Please excuse all my typos!
emcs
5 Sep 2024
Hi, WildcatVet. I had my appointment with my NP and she isn’t willing to change any of my med. She said the 200mg of Lamictal is the most one can take per day and felt that changing mirtizapine would not be a good idea. So, I’m not sure what to do at this point. Suggestions?
My therapist did give me the name of a psychiatrist today, which I was waiting for, but I don’t know if he’s taking new patients. I did email him to find out and I doubt it. There are no providers to change to which is a real problem. I’m totally confused as to what I should do as I feel terrible. Anything you might lend is greatly appreciated.
WildcatVet
6 Sep 2024
@emcs
First off, you do have the legal right to contribute and make decisions in your treatment plan, just so you know. Does she understand the shape you're in?
Follow up on that psychiatrist and see where that takes you. Do you have anything like a mental health clinic accessible to you? Do you have a GP who could intervene or who might be able to give you a referral?
I understand. I live north of the north forty and was lucky enough to find a NP that I liked and respected. She worked with a psychiatrist who was great too. It must be so frustrating for you!
It's admirable that you're reaching out for help. You can feel proud of that.
Stay in touch and best of luck to you. WC
emcs
8 Sep 2024
Thanks again for your thoughts/suggestions. I finally made contact with the psychiatrist, now have to wait for him to be accepted by various insurance companies. He said he’d see me after that & does only tele health. It will be awhile. All I can do is wait. I called The NP said she wouldn’t add anything new as it could cause a problem with serotonin syndrome. What I’ve found is that BuSpar wouldn’t interact with anything I’m taking. I think I’ll try to reach her again, which isn’t easy, and ask if she’d add that. Does that sound like a logical request? I have to do something is all I know. Any other suggestions? I can’t tell you how much I appreciate your input.
WildcatVet
8 Sep 2024
:( :( :(
I'm afraid you'll get a resounding no on the buspirone (BuSpar} because it does, in fact, have a slight risk of interaction with your mirtazapine. That combination can cause serotonin syndrome in a small number of cases.. It's rare and easily treatable in the early stages but your NP may veto the idea. I would still inquire about that option though because... why not? It couldn't hurt.
Just a thought. Could you find an online or telehealth agency that will support you? Even just talking with a caring soul sometimes helps a lot. My NP and psychiatrist are both in Florida and I live in New York... we communicate via telehealth on Zoom.
Do some research and see what might be out there.
emcs
11 Sep 2024
Wildcat, I’m sorry…I wasn’t able to post a reply on my first couple of tries. I put a reply to you in the upper comments section of this thread, if you could please take a look. Thank you.
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klonopin, lamictal, depression, anxiety, mirtazapine, dosage, medication, treatment, combination
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