Question: I am having trouble with my psych meds. I am taking 5mgs/night of Brintellix and also taking 5mgs Celexa and 175mgs of Lamictal. After almost two weeks of having added the Brintellix I am getting foggy and aggitated mid-day. It is a very small dose of both SSRI, but the 5htia action of the Brintellix is very helpful to me for cognition, anxiety, etc and augments the celexa. I'm wondering if I am at risk for serotonin syndrome and that this is what is causing the agitation, despite the low doses. Or that the opposite is true and I need to increase the Brintellix. I feel best in the morning when I take my Celexa and lamictal and don't start feeling bad until two or 3 in the afternoon. Also, I am taking Atripla, which I know speeds the metabolism of Brintellix and this may cause the late-day swing.

Thank you for your well-thought-out answer! My doctor just shrugs and says "that doesn't work" which I didn't think was the whole answer, which is why I am looking for complementary advice.

For the sake of completeness, I thought I would add that:
I also take about .25 mgs klonopin/day (which I need less with the Brintellix);

I occasionally take ritalin or adderal in tiny doses for energy or focus. Sometimes it makes agitation and concentration better, sometimes worse. I took some today b.c I was feeling very foggy around 2pm. It seemed to help with the sleepiness but didn't make me feel less agitated. During my last trial of Brintellix one year ago, the stimulants helped me with an apathetic, dysthymic feeling that accompanied it. Granted I was at a much higher dosage and was completely off the celexa.

Also my agitation/depression/cognitive issues (typically, not the new Brintellix-related incidents) tend to resolve with food and caffeine, even though just for just a few hours before they come back.

Also, I seem to have an interesting relationship with other 5ht1a agonists. When added to my SSRI, buspar did an amazing job at helping my concentration and anxiety, but resulted in extreme irritability after a few weeks. I had somewhat less pronounced irritability with latuda. Zoloft (while not a 5ht1a agonist) similarly caused improvements in concentration but also irritability. I took Risperidone with Serzone and was nearly hospitalized.

So to follow up, do you see any problem or benefit with the Klonopin? (I know better than to just stop taking it) Or a problem with occasional ritalin/adderal? I know Brintellix is a mild NE transport inhibitor and I don't want to become overstimulated. I know people with BPD in the family can react poorly to drugs in the buspar class.

Thanks again for your help! People with complicated histories need all the help they can get advocating for themselves.

Cheers

so I tried adding a daytime dose of the Brintellix yesterday and it seemed to make things a little more foggy. Even if it wasn't a serotonin syndrome I suspect the Brintellix clashes in some way with the Lamictal and/or celexa. After that experience I decided I wanted to see how I was able to handle chemistry class and quantitative calculations without the Brintellix, so I didn't take any last night.

I returned to a familiar situation today: I would take my normal 5-10mg Celexa and 100 mg lamictal in the morning and be fine for a couple of hours, and would then slump into a very tired/low cognition state. It was this "I just can't think straight" problem that precipitated the brintellix trial in the first place. It usually lasts for a couple of hours but it is at a time of day when I really need to concentrate.

I faced a similar slump during my trial of Viibryd. About noon or so I would get so tired the doctor had me taking ritalin daily just to keep me functioning and awake.

I seem to remember last semester that holding off on the lamictal (taking it at lunch instead of in the morning) would push this tiredness off, and it would be less pronounced, but it still happens just the same. It seems that this is a direct result of the lamictal in combination with the SSRIs? Can you comment on this or suggest why this is happening?

Strangely I don't take as much lamictal at night because it tends to disturb my sleep. At higher doses of Celexa and/or lamictal the opposite seems to be true, and I became somewhat racy when I take them together.

I know lamictal reduces glutaminergic activity and can impair cognition, but if I go too low on my dose I become pretty depressed and obsessive over time.

I wasn't thinking that the sleepy/cognitive problems that I get after taking the lamictal were serotonin syndrome related but they are concrete. If I don't take my Lamictal in the morning the symptoms don't occur.

Regarding the afternoon lethargy and cognition problems...even though I am feeling sedated you think that they would respond well to klonopin?

Currently I am taking 100mg morning, 50mg late afternoon, and 25mgs at bedtime. I used to take 100mg BID, morning AND night, but the nighttime dose interferes with my sleep. I used to take 400mgs daily but the cognitive issues were too much.

the problem is I have been taking Lamictal and Celexa for 10 years now. Whenever I try to lower the Lamictal I become incredibly depressed and socially terrified about a week later and it is terrrible. The mood only improves with large amounts of food caffeine, and then bottoms out again after an hour or two.

I feel I am both dependent upon it but also becoming somewhat poisoned by Lamictal.

Does it make sense that the foggyness and irritability is more likely to occur when I take it with my SSRI? This doesn't occur later in the day, but then the amounts of Lamictal later in the day are lower also. Strangely I blamed the cognitive problems on Brintellix or Viibryd when I tried those but I way also taking them with Lamictal!

Do you think taking Modafanil (or Adrafinil which is available online) would help with these problems? Stimulants work in the short term but increase anxiety. I tried taking supplements to increase glutamate but that actually felt really terrible too.