# Clomipramine augmented with lamotrigine (Lamictal)



## stringbean (Jun 25, 2011)

hi all, havent posted for a while but wondered if anyone had any advice. Started on clomipramine for ocd back in January and found it very helpful but had to increase it to 175mg after a relapse in symptoms. and didnt quite work the same again my Dr has now augmented it with lamotrigine as he feels that my ocd ciould be helped by this and also the depression that gets to me every time my ocd gets bad.Trouble is i can only find limited advice on ocd treated with lamotrigine and so worried about the deadly rash that you can get and now i am obsessing about that and also keep thinking the dr isnt being straight with me and thinks its not ocd but something else


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## Dragonfly (Jun 25, 2011)

Hey stringbean - welcome back!  First the caveats - no one here on Psychlinks can offer an opinion specific for you and your situation.  Each person is unique and only a provider who has all of the pieces of you story can really comment to you specifically.  Having said that, here are some generalities - the maximum dose of clomipramine is 250 mg.  Some providers may go above that, but above that there is a significant risk of increasing dose-related side effects (like the possibility of seizures).  In the greater metropolitan area of Seattle, I am reasonably comfortable saying that MDs would not augment clomipramine with lamotrigine (that is, lamotragine wouldn't be used to make clomipramine more effective).  Rather, someone might prescribe lamotragine in the situation you are describing if the provider believed that (say) mood instability and particularly depression, were making the symptoms of the ocd worse.  I can see where, in casual parlance during an office visit, the provider shortening all this to ".... [lamotragine] will help your ocd."

stringbean - thats one way to look at what you are asking.  Another is to use your "obsessing about that and also keep thinking the dr isnt being straight with me ...." and find the strength / courage / belief in yourself and directly ask your doc.  Of course, to do this takes not only an enormous belief in yourself, but the ability to listen and actually believe what is said in response.  

Again, welcome back!  Please let me / us know how you are doing.


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## Andy (Jun 25, 2011)

As far as the rash goes Stringbean, it is a scary thought but it is very rare and you would have to leave it for a long time without medical attention in order for it to become deadly.  If you spot a rash then go to your ER, it really isn't super common from what my doctor told me, they just have to make sure your aware in case if it does happen you aren't ignoring the rash thinking it will go away when you should be getting treatment. Just make sure you take your medication as prescribed and when increasing/decreasing do so slowly. 

I hope that put your mind at ease a bit. It really is one of those rare side effects.


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## stringbean (Jun 26, 2011)

Thank you so much for these responses they have helped alot.

Dragonfly, I have spoken quite honestly with my Dr and he has said alot of words of wisdom but think my ocd has got in there and is triggering things.And also surfing the net didnt help!!

My dear dr has said that after suffering 20 odd years trying various meds along the way, some working some not, stopping them restarting etc that it is time to get rid of this or at least make it bearable.

He has reassured me its not biopolar (no disrespect to any one with this illness but that was one of my ocd fears) and assures me we will get this sorted and i will be better again. 

When he prescribed the lamothingimy(too hard to spell) he said it was to even my mood and make the good periods more stable.

I just have two questions and i cannot get hold of my Dr for two weeks.

1. Would it be correct to prescribe it for bog standard depression
2. Can i take B12 complex with both of the drugs.

One reassurance is if the clompramine cause seizures then the other one will stop them. 

Sorry for my gallows humour but that is my bravado.

Again thanks so much for answering, you do not realise how much i respect and appreciate your replies from over the water


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## stringbean (Jun 28, 2011)

*Clomipramine and mood stabilisers*

HI there, .
My dr added a mood stabiliser to the mix of clomipramine and took a low dose of that for three weeks until reaction  yesterday and so had to stop.

I am now worried that i am going to get really bad again and been obsessing about it.

Can anyone tell me how long to get the maximum benefit from clomipramine, i have been on 175mg for 11 weeks now and i have had good times as well as bad times but the last three weeks more good than bad, I would like to think its the clomipramine getting to a good level but terrified its the mood stabiliser that i had to stop(perhaps a few weeks isnt enough to get a result from ms) 
	

	
	
		
		

		
			





Please anyone advise


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## David Baxter PhD (Jun 28, 2011)

_New thread with previous thread to avoid duplication or replies._


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## stringbean (Sep 1, 2011)

I am going to try the lamotrigine again due to the side effects with olanzapine being too numbing, just wondered if anyone else had any experience with it? I am hoping that i wont get a skin reaction this time!


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## stringbean (Sep 5, 2011)

*Lamotrigine - Lamictal*

I tried this med for about five weeks and had good results but then got worried about the rash and when i got a sore up my nose my gp said to stop taking it.

I then went onto olanzapine and been on that for a month but finding that i am suffering from lack of concentration and not getting that good results.

My pyschiatrist told me to try the lamotrigine again, I am tempted as i feel so awful, has anyone else been on this had a reaction and tried it a second time? 

I am just terrified of the rash but as i said i feel like i would rather die than continue to feel this never ending doom and panic.


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## Retired (Sep 5, 2011)

*Re: Lamotrigine - Lamictal*

It is my understanding that skin rash is an important adverse reaction in some people taking lomotrigine, and any occurance of a rash should be reported to the doctor immediately.

Was the doctor convinced your previous irritation in your nose was caused by the medication, or was the discontinuation just considered precautionary?  Not al rashes are necessarily drug related, so it might help clarify your concerns is you discussed it with the doctor.

In your conversation withyour doctor about the risk of restarting lamortrigine in light of your past experience?

If you and your doctor conclude that lamotrigine should be given another trial, be sure to tell your doctor about all other medications you are taking, so your doctor can manage any potential drug interactions with lamotrigine.


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## Daniel (Sep 5, 2011)

*Re: Lamotrigine - Lamictal*



> Was the doctor convinced your previous irritation in your nose was caused by the medication, or was the discontinuation just considered precautionary?



Yeah, that is what I was wondering, especially if your doctor did not see it.


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## stringbean (Sep 6, 2011)

*Re: Lamotrigine - Lamictal*

hi both and thank you,you really are a life line.
To be truthful I went to see a GP and she did look up my nose and said it looked red and to stop taking it but my psychiatrist didnt see it so therefore he was skeptical that it was the rash.

the way i am feeling at the moment i think i would risk it to feel better.

does anyone know if you can take it with olanzapine as i have taken my 2.5mg dose this morning.


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## Retired (Sep 6, 2011)

*Re: Lamotrigine - Lamictal*



> does anyone know if you can take it with olanzapine as i have taken my 2.5mg dose this morning.



It would be unwise to begin restarting or modifying your medication regimen without first consulting your doctor. In view of the circumstances you've described, your best advice would be to first speak with the psychiatrist you are seeing to review your situation and advise you on how to make the transition, if indeed happens to be appropriate.

For your own safety and good health, do not make changes without explicit instructions from your doctor.


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## stringbean (Sep 10, 2011)

*Re: Lamotrigine - Lamictal*

hi all, I am back on the lamotrigine and due to me being paranoid about the rash, my husband is keeping an eye on me. 
As it wasnt confirmed to be a harmful rash and it was more the gp being cautious my pysch said to try it again.

I had a really awful day on Tuesday and that decided it for me, so i took my first dose, the next day i awoke and felt so much better(must have been psychological) and Thursday was good too.BUT the last two days have been bad again .
When i took it last time i was on 25mg for two weeks and felt brilliant but my Dr had said it would take up to a month to get to a therapeutic dose! Can anyone offer me any advice, how long before the mood stabilizers effect kicks in and i start to feel better, think i was expecting to be the same as previous.


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## David Baxter PhD (Sep 10, 2011)

*Re: Lamotrigine - Lamictal*

Since you've been off it for a while, I would guess that it would be the same as before... a month or so. But double check with your doctor or pharmacist.


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## Retired (Sep 10, 2011)

*Re: Lamotrigine - Lamictal*

Stringbean,

You may find some of the answers to your questions about lamotrigine in these Drugs.com articles:

lamotrigine medical facts from Drugs.com

and this one, that describes the escalating dosage regimens for this medication:

Lamotrigine Dosage - Drugs.com

Your doctor may be recommending a different dosing schedule based on your own specific needs, your medical history and your doctor's clinical experience with this medication, so your doctor's instructions should be followed.


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## stringbean (Sep 11, 2011)

*Re: Lamotrigine - Lamictal*

Thank you so much for your replies, Dr Baxter last time i took it i felt better the next day and it lasted for two weeks, now I am worried that they are not going to work this time.


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## David Baxter PhD (Sep 11, 2011)

*Re: Lamotrigine - Lamictal*

Just be patient and give it a bit more time.


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## stringbean (Sep 20, 2011)

*Lamotrigine / Lamictal*

HI all, well after a lot of soul searching have gone back on this drug.

When i first took it got to week five and had a sore up my nose so my gp stopped it. I have since tried something else but this drug really did work and quickly (for me)
So after a months break I have been back on it for two weeks. One problem my ocd has latched onto it and I am convinced I have a rash! Again i had a sore part by my nose but think it was just a scratch and i have some spots on my buttocks (my husband says they have always been there) but i have been looking up sjs and the horrible prognosis if it is a reaction! Also my neck feels itchy???

I have come on here to get impartial advice, as although i think it has helped my mental health, I am terrified and every little itch is panic inducing! 

Please someone reply


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## David Baxter PhD (Sep 20, 2011)

*Re: Lamotrigine / Lamictal*

Keep an eye on things but tyry not to overreact. Keep reminding yourself that most of us scratch little itches or have various skin pimples on any given day and the vast majority of them are nothing.

If you develop a real skin rash, have oit checked but otherwise try to ignore the OCD thoughts: Remember that this is just your way of worrying and trying to keep yourself safe. As Daniel has said, they are just thoughts - you do not need to act on them.


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## stringbean (Sep 20, 2011)

*Re: Lamotrigine / Lamictal*

Thank you Dr Baxter, Have you ever encountered somebody that has had the dreaded reaction to Lamictal?


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## David Baxter PhD (Sep 20, 2011)

*Re: Lamotrigine / Lamictal*

No. As your doctors have told you, it's quite rare. It's serious when it occurs but it's fortunately quite rare.


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## Retired (Sep 20, 2011)

*Re: Lamotrigine / Lamictal*

I believe that in a situation such as yours where a particular adverse reaction is associated with a medication, that we need to rely on the expertise of the prescribing physician.  Your observations are important, and if you feel you need to follow up, then make an appointment with the doctor and have it evaluated.

The doctor knows the criteria to look for, so you will be told if it is an adverse reaction or not.  If it is not, then it would be in your best interests to focus on the beneficial effects of the medication, as you have already told us you have experienced relief of your symptoms in the past.

So if you need reassurance, see the doctor.  Once reassured, focus on getting better.


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## stringbean (Sep 20, 2011)

*Re: Lamotrigine / Lamictal*

Thank you for your replies, I have spoken to my Dr and he said unless i have a new rash (not just my spotty bum) and or hives or blistering then I should continue the meds. They dont seem concerned that i have gone back on it after having stopped it due to the sore i had last time.

I am trying very very hard to focus on the positives but just dont seem to be able to get past the fear, maybe its not worth all the worry.


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## Retired (Sep 20, 2011)

*Re: Lamotrigine / Lamictal*

You may find consolation in Dr. Baxter's earler comments in post #2



			
				David Baxter said:
			
		

> If you develop a real skin rash, have it checked but otherwise try to ignore the OCD thoughts: Remember that this is just your way of worrying and trying to keep yourself safe. As Daniel has said, they are just thoughts - you do not need to act on them.






> I am trying very very hard to focus on the positives but just dont seem to be able to get past the fear, maybe its not worth all the worry



By reaching out for support here and by speaking to your doctor, you are collecting the information you need to make a rational decision.  You have already told us the medication helped relieve your symptoms in the past and that you have chosen to restart the medication because you could not bear living with the symptoms when you discontinued the medication once before.

Available information, according to your doctor is that you can safely continue your medication and that you are not experiencing a rare side effect.

Your task now is to process that information to make it your reality so that you can focus on getting better, looking toward the future.

There are risks and benefits in just about everything we humans do every day, from walking across a street in traffic, to flying in an airplane or taking our medications.

In all these situations, the benefits far outweigh the risks, which is how we make our day to day decisions.

I believe in your case, Stringbean, the benefits of your prospective improved mental health far outweighs the risk of a rare side effect about which your doctors, who know you and your medical history, have reassured you.


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## stringbean (Oct 2, 2011)

*Re: Lamotrigine / Lamictal*

back again and feel a little silly now looking back on the posts! unfortunately I could not get past the fear of a rash and my ocd latched so much on it that it was doing me more harm than good and myself and my pdoc decided to stop this medication.
I have been seeing my doctor for -9 months and in that time have had some good results from clomipramine and at times thought that i was actually getting somewhere but the results have not lasted. The best i felt was on the mood stabiliser lamotrigine. I am now having cbt and have just started on lithium to augment the clomipramine so I am hoping that i will get some results. I am a little confused as a first i had lamotrigine (mood stabiliser) then tried olanzapine _a anti psychotic and now a mood stabiliser again, not sure how it all works>


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