Psychiatric Medication Conundrum

Ok, here’s my situation. I recently began seeing a psychiatrist due to my worsening depression. I was already taking 100 mg of Zoloft/day going into this treatment. I left my first appointment with a prescription for 25mg of Lamictal, which is a very small dose. This medication needs to be gradually increased due to potential skin issues. My next appointment was for three weeks later.

Well that appointment comes and I tell the doctor that I hadn’t really noticed much of anything in regards to the Lamictal and that my depression was really having noticeably negative effects on my daily life. I also mentioned my long-standing insomnia and told him that I really had been having extreme trouble sleeping. So, I leave that appointment, which was Monday (it’s Friday evening as of the posting of this thread) with prescriptions for an increase of Lamictal, from 25mg/day to 50. Also, I was prescribed 100mg of Seroquel to take before bed for sleep.

I started both of these new prescriptions, the increase in Lamictal and the Seroquel, at the same time. Within less than even 2 days, I noticed a significant improvement in my depression and mood. And I mean SIGNIFICANT. And it wasn’t a cloudy-headed fog of “I don’t care” feelings either. I just felt good. I was extremely surprised at the speed and effectiveness of these new prescriptions but I didn’t know which one to attribute my improvement to.

Now to the bad stuff. Right about the same time as I noticed these drastic mental and emotional improvements, I also noticed an almost total loss of libido and ability to achieve and maintain an erection. And I mean TOTAL. This is just unacceptable and really takes the shine out of the positive benefits of these medicines. I can’t trade one unlivable condition for another.

So this is what leads me to this thread. While the psychiatrist did prescribe the Seroquel for insomnia, he also told me that it could benefit my depression as well, as it was also commonly prescribed for that in bipolar patients. Now, given the fact that I started both the increase in Lamictal and the Seroquel at the exact same time, I’m not sure which medication is responsible for the benefit. How do psychiatrists determine which medication is responsible for which effect? Given the fact that I had already been on Lamictal for the previous three weeks, albeit at a lower dose (with no improved mood but also no sexual dysfunction), I am gravitating towards the idea that the Seroquel is responsible for both the improvements and the drawbacks.

I guess my question, to the MDs of the SDMB, is what seems more likely to have caused my sudden improvement as well as the sudden side effects? Seroquel has more of a reputation to be a libido killer, that is why I’m leaning towards that as being responsible but I don’t want to stop that drug and then fall back into my depression.

(And of course, I plan to discuss all of this with my doc just as soon as I can. I’m not posting this here in place of his care. Just looking for info)

Medical advice is better suited to IMHO than GQ.

General Questions Moderator

Reported for forum change.

Also, a few days (or weeks, even) is IMHO not nearly enough time for anyone to evaluate a psych meds cocktail.

I suggest the website for more indepth information.

Oops, ninja’d, you guys are fast.

I know it’s only been a very short time but nonetheless, these changes have occurred. I’d like to hear opinions on which medications are more likely to have caused them, irrespective of timeline.

Thanks for that link! It’s quite helpful. :slight_smile:

Doctors these days giving out all sorts of pills like candies. They don’t know what causes what and what helps and why. They are paid to dope you up like a racing pony while they themselves don’t have to suffer any of the side effects.

I don’t like any of it. That cocktail of drugs you’re on sounds like it could be messing with anything and everything. Do you like being dependent on drugs? I sure don’t.

Is this bipolar med you’re on actually helping for your insomnia? If not then get rid of it. The smaller amount of drugs your body is dependent on, the better.

If three people send you to, maybe you ought to go to crazymeds. Has worked for me.

Your doc will make a best-guess adjustment to your meds, and you’ll both find out what happens by frequent monitoring. The adjustments might include substitute drugs or changing dosages or both.

Or neither – it’s possible that erectile dysfunction is a symptom that may decrease or disappear over time. So maybe your doc will suggest staying with what you have for a while, since it seems to be working so well for the condition you initially reported.

Please note, I’m not a doc, but this is what they do for most any combination of drugs.

If treatment for insomnia were the only possible benefit I was getting from the Seroquel, I would have already stopped it. But that is the point of this thread; I don’t know if the Seroquel is what is responsible for my substantial improvement in mood and depression. And that is something for which I cannot be more thankful. Seriously. I don’t want to stop the Seroquel and go plunging back down.

I do not like being dependent on drugs, no. Not at all. But you know what I dislike even worse? Hating myself and not being able to make it through a day without breaking down in agonizing tears. I don’t like that at all. If I have to take a couple of pills every day to feel like myself, it’s not even a question.

Lamictal takes a while to get in your system because of the small early dosing. After a while it really, really helped me. Of course, it might not work for you but after spending nearly 30 years battling depression it was a miracle for me. (I worked up to 200mg a day)

Well ideally I would hope that the tremendous (miraculous could be used, I’d say) improvement I’ve seen can be attributed to the Lamictal and the sexual dysfunction can be attributed to the Seroquel. That’s what Im hoping for anyway. I was on the beginning dose of Lamictal for three weeks and had NO sexual dysfunction at all. It wasn’t until the introduction of the Seroquel that the sex problems started, however, at the same time I also increased my dose of Lamictal. Ugh.

See and that is why it’s such a roll of the dice to rely on anecdotes…I worked up to Lamictal 200 mg as part of my cocktail and was faithfully compliant for almost three years until I realised it had made me so stupid I could barely write my own name. And that’s not exaggerating, at least not by much! Titrated off it and I got my brain back. (Well, sort of.)

Ambivalid, hope the crazymeds site helps. Lots of crazy people there LOL but I think it’s a pretty good resource.

I can’t speak to ED but for insomnia 50 mg Trazadone as needed works well.

I’ve never been to crazymeds before. Looks like there’s some good reading there.

Not really. Less than a week, which is the time period you mentioned in your OP, is not enough time to determine that “changes have occurred”. Your body’s still adjusting to the new regime. In a couple weeks, you’ll have a dosage built up in your system and your body will start to compensate. But sure, do talk to your doctor about it. That’s always good advice.

I’m in the middle of weaning myself off Ambien. It helps with my insomnia but leaves me very little energy during the day. I might ask my doc about Seroquel. He said he has some ideas I can try. A medicine that makes me feel good - man, that sounds nice.

I didn’t get any sexual side effects fortunately. Either way, best of luck in finding what works the best for you.

Agreed. One persons miracle drug can be another persons nightmare.

I’ve been on the beginning dose of the Lamictal for three weeks prior, so I’ve had some level of that drug in my system for one month now. And according to the crazymeds link, Lamictal can begin to work in as little as 2 days. There is absolutely no doubt whatsoever that my depression has lifted tremendously. And it has coincided exactly with the increase in the dose of Lamictal and the introduction of Seroquel. There has to be a reason why. I’m not suggesting that what has happened is a permanent change, I just want to know which med is responsible for which effect.

NIAWAD- Not in any way a doctor, but I have been in treatment for depression, anxiety, and suicidal ideation for most of my life. I’ve had to switch meds a few times because they stopped working for me or the side effects became unbearable, as you found out. Then the process begins again to find what will work for me.

Not all medications act the same way for everybody, and you may have to try several different meds or combinations until you find what works for you. Sometimes the side effects go away or become tolerable, and sometimes they get worse. Working with your doctor is definitely the best route and not just because he/she can write prescriptions.

Blah, blah, blah. What I really want to say is this- Good on you for seeking treatment when you needed it and please stay hopeful that something will work for you soon.

No, but it is enough time to make you manic at the wrong dosage if you’re actually bipolar and not just depressed.

Keep an eye on yourself, Ambivalid, to make sure you’re not becoming hypomanic. Lamictal can, but usually doesn’t, trigger manic episodes.

Seroquel has many more side effects than Ambien. Check it out for yourself. It’s kinda scary. :eek: ETA: Oh yeah, and it didn’t even work for my insomnia.

Weeks… try months. They want you to pay money for their medications for months before they admit that it might not be working perfectly. It’s a sweet deal for them; not so much for the person that has to deal with the side effects for that entire trial period.

Your body having to compensate and strain itself to correct the imbalances caused, given as positive advice is quite a frightening thought. Your body doesn’t want the chemicals there.

I guarantee your doctor doesn’t even really know if the Seroquel is what is responsible. They have their exceptionally long lists of possible side effects that sometimes occur and rarely occur with each drug, and they will hmm and haww and tell you to stay on it longer. They always do.

Yourself is not who you are on drugs. That is yourself on drugs.

In my day, young healthy folk never got put on so many different medications. This new chemical culture astounds me.