[Scayax92]

Good morning everyone,

I've already posted in the wrong section, excuse me.

I'm an italian patient suffering from dissociative disorder not otherwise specified (DDNOS). I would like to have some information about the pharmacotherapy of that disorder. I know the London Mix, such as a SSRI, clonazepam and lamotrigine. I'm currently taking 2 mg of clonazepam (as aid for sleep, to be increased to 3 mg), 200 mg of lamotrigine, 30 mg of mirtazapine (for headache prevention), 200 mg of sertraline, 300 mg of pregabalin (for GAD), 20 mg of olanzapine, 450 mg of bupropion, 200 mg of amisulpride (for prevention of nausea) and 0,7 mg of pramipexole (to reduce prolactin levels increased by amisulpride).
I would like to optimize my therapy, because it's a very heavy pharmacotherapy. In particular, I would like to know the recommended dosage of lamotrigine and clonazepam. Is it worth changing sertraline for fluvoxamine (I've read some information on this forum...).
I am being treated by a psychiatrist and a psychologist. Is a good idea having two different therapists? I'm so confused having two different visions of my disorder.
Thank you for reply.

Sincerely,
Marco

 

[Scayax92]

Please help me!

 

[TDX]

My first impression is that your drug cocktail is well off the charts and doesn't look very meaningful. I mean for example you are taking olanzapine in a high dosage, which blocks the very same dopamine receptors that are activated by Pramipexole. This makes me wonder if the Pramipexole can actually do anything. Beside this it would also cancel out the (rather weak) dopaminergic effects of Bupropion and Amisulpride. Another question would be if it makes sense to take Pregabaline if you already take a benzodiazepine. To me your cocktail looks like it has a lot of redundancy that probably won't help for your symptoms, but instead will increase your risk for side-effects and longterm effects (like tardive dyskinesia from olanzapine) and will give you a hard time when you want to come off them.

A "recommended dosage" for the London Mix doesn't exist, because there were never any clinical trials about this drug combination. The name "London Mix" originates from this forum, because the Depersonalization Research Unit in London is supposed to have sometimes used this combo. Dose recommendations only exist for Lamotrigine. The target dosage is 400 mg/day, but some people have also used 600 mg/day or even more.

Regarding SSRIs it is known that for depression no SSRI seems to be better than another. We don't know if this is also true for depersonalization disorder, but we know that their success rate is very low anyway. Switching does mainly make sense when side-effects are a problem, because for some people different SSRIs have different side-effects.

 

[106473]

What TDX said.

2 mg of clonazepam

200 mg of lamotrigine

30 mg of mirtazapine

200 mg of sertraline

300 mg of pregabalin

20 mg of olanzapine

450 mg of bupropion

200 mg of amisulpride

0,7 mg of pramipexole

Have a step back and look at that list. Mind blowing. Did you add these in slowly? how long have you been on such a med list?

I can't believe a doctor would give you such a list. You are getting pushed and pulled in every direction. Bet you'd feel better on 3 things on that list that were working.

Clonazepam doesn't solve anything, it's SHORT TERM relief. People who have been on it long term say it was a big mistake.. not something to shrug off.

Lamotrigine isn't in range... i'd get up to 400 for a month or two and if no change, tapper...

Where to even start. I'd go back to 1 medication for depression.

Certainly no doctor in the UK would EVER have you on such a cocktail. I honestly think taking half of them medications would have better results (at least half!)

 

[Scayax92]

Thank you very much for your replies.

My therapy now is:

2 mg of clonazepam

200 mg of lamotrigine

30 mg of mirtazapine

200 mg of sertraline

300 mg of pregabalin

20 mg of olanzapine

200 mg of amisulpride

10 mg of aripiprazole, to be titrated to 15 mg.

How can I do the titration of lamotrigine from 200 to 400 mg?

 

[TDX]

How can I do the titration of lamotrigine from 200 to 400 mg?

Increase by 25 mg each week. But these are things your doctor should have told you.

And I can only repeat that it would be a good idea to drop all the medications that "work against each other". I would especially drop the antipsychotics if there is no real rational for using them. Some people with schizophrenia take multiple antipsychotics. For example during my time at a psychiatric clinic I met a person who took 5 different antipsychotics including Clozapine. Perhaps for them this makes sense, but I don't see a reason for doing this for someone with depersonalization disorder only. I don't know your situation, so perhaps this huge cocktail is the right thing for you. But taking high doses of antipsychotics and likely also taking multiple antipsychotics over extended periods of time can cause in the long run some irreversible effects, like tardive dyskinesia. You should ask yourself if you really get a meaningful improvement by them and if it really is worth the risk.

 

[106473]

I'm confused. Either you are adding these medications in yourself or your doctor isn't good, or you aren't going regularly enough. To me it sounds like some or maybe a few of those factors. Listen to TDX, i said you are getting pushed and pulled everywhere with that medications, i.e. what TDX said they are "working against each other"....

Lamotrigine is not to be messed with, need slow 25mg build up, need to talk to your doctor about it and do not quit without a long tapper, trust me and many members on that one, plus seizer risk is very real.

 

[TDX]

Lamotrigine is not to be messed with, need slow 25mg build up

Only before reaching 100 mg/day where it should be increase by 25 mg every 2 weeks. Afterwards the dosage can be increased more quickly.

 

[James2368]

I have taken the „London mix“ for a couple of years now. This has helped me a lot to get better. Clonazepam is difficult to reduce after a while as it makes addictive but it was the only way for me to get back into life again

 

[Scayax92]

Thank you. In the famous “London Mix”, exactly, what are the doses of drugs? For esemple, lamotrigine must be titrated to 400 mg according to “London Mix” or 200 mg are sufficient?

 

[James2368]

It always depends from Person to Person, for me it was a mix of 400 mg lamotrigine, 2 mg clonazepam and 20 mg fluextine. But like I sad, every Person is different...