Question. My sister has been suffering for years with depression and is what has been termed a “difficult case.” Generally, she tends not to react normally to drugs. Side effects seem to be accelerated, so nothing has the desired effects. She has had numerous ECT treatments, with relative success but short lived and with plenty of memory loss. The latest drugs they would like to try her on are: Wellbutrin and Lamictal. Do you have any information on them and their side effects?
Answer. I’m sorry to hear of your sister’s refractory depression. Wellbutrin [bupropion] is usually a well-tolerated antidepressant, with very little tendency to sedate the patient; in fact, some patients may be somewhat hyper or agitated on high doses of bupropion (greater than 250 mg/day). The most common side effects of bupropion are restlessness, tremors, insomnia and mild nausea–but these are not seen in the majority of patients, in my experience.
Patients with a history of seizures are not good candidates for bupropion. Lamictal (lamotrigine) is approved by the FDA for use in “partial seizures” (a form of epilepsy), but has recently been investigated as a mood-stabilizer for use in bipolar [manic-depressive] disorder. Preliminary results are encouraging, but there are no published, controlled studies, as far as I know. I am not familiar with its use in non-bipolar (unipolar) depression.
Fairly common, dose-related side effects of Lamictal include dizziness, blurry or double vision, difficulty with balance/gait, nausea, and vomiting. However, when compared with a placebo (sugar pill), none of these side effects occurred in more than 27% of patients, except for double vision (at 300 mg/day, 24% of patients taking Lamictal experienced this vs. 8% taking placebo; when Lamictal dose was raised to 500 mg per day, the incidence of double vision rose to 49%).
By the way, has your sister been tried on an MAOI-type antidepressant? I have often found an MAOI useful even in patients who did not respond to ECT. Some patients do well with monthly “maintenance” ECT; when given unilaterally (i.e., to just one side of the brain) memory disturbance is usually minimal.
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