Mental Health Advice wanted please! Lots of different psych meds altogether

[lolsem]

Hello everyone,

I have had a look around to see if there's somewhere better I could have posted this but I can't really find a suitable thread

If it's in the wrong place or anything I apologise :/

I've searched the internet I've looked everywhere but hoped you guys could help me better!

I take esitalopram (lexamil), Quetiapine (Seroqual), carbamazepine (Degranol) & lorazepam (Ativan). I'm bi-polar & suffer from panic attacks. Am actually a recovering drug addict who was in rehab for 3 years thanks to God I managed to kick the other stuff so far.

I have a feeling carbamazepine stops my other meds working so well because of it being an inducer of certain liver enzymes (CYP & UGT) which would reduce the other medications concentration in my system by metabolizing them faster. So am thereby questioning whether the medication works so well in me.

If there's anyone out there who might be able to add to this discussion or help me figure this out it would be awesome!

Hope I'm making sense

 

[flyhighk]

You're very right. Carbamazepine may be reducing the blood concentrations of the other drugs you're taking, thus making them less effective. You have two options : stop the carbamazepine or increase the dose of the other meds. I think you should discuss this with your doctor.

 

[checktest]

Carbamazepine does classically interact with the metabolism of a lot of drugs, including itself. Multi-mood stabilizing setups with any combination of lamotrigine, carbamazepine, and valproate/valproic acid are pretty notorious for requiring some finesse for dosing and dose changes.

CYP3A4 is pretty big for quetiapine, and the benzo effects usually are reduced. Talk to your psych about symptoms and he/she will likely modify a bit. Again, carbamazepine interacts with itself, so usually it requires a test period for changes.

I have a friend on Lamictal and carbamazepine, amongst who knows what else now, who is always having her meds adjusted. Her psych prefers to do that rather than go for full stability.

But yeah, don't increase your benzo dose or whatever without checking in first.

(And try to avoid grapefruit. Not as bad as Buspirone in that regard, 300% or whatever, but not worth it adding another factor.)

 

[lolsem]

Thanks guys for the info I really appreciate it, I've been really unstable recently and very little my psychiatrist seems to be doing is having anything but a very short term effect! But thank you