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07 Aug 2007

Two questions: Lamictin; psychotherapy
Dear doc. Hope you don't mind me asking two questions at once: 1) I wrote earlier about changing meds at the moment (Effexor to Cymbalta). I'm also on 200 mg Lamictin. I am extremely irritated most of the time, which is not really part of my character. Can it be that the Lamictin causes it? I have not experienced it on Cymbalta or Effexor before but it only started when I started taking Lamictin.
2) What is your opinion about psychotherapy: My psychotherapist suggests long-term therapy, seeing that I've had extreme anxiety issues since childhood. It's also genetic.

Thanks.
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Expert
CyberShrink
cybershrink

01 Jan 0001

1. I wouldn't expect the Lamictin to cause irritability, generally, because it is also valuable as an anti-epileptic drug, as well as a mood stabilizer, which is ratehr the opposite effect to irritability. Now, when one combines it with Cymbalta AND Efexor, who knows what might hap[pen to the complex chemistry, as I'm pretty sure nobody has ever researched such a combination, because it would rarely arise.
2. I think the issue is clear. IF one is talking about very specifically Cognitive-Behaviour Therapy ( CBT ) then I enthusiastically recommend it for Depression, anxiety, and a host of other problems, for which there is good hard scientific evidence that it is valuable, produces lasting benefits, and doesn't take forever.
For ANY other varety of psychotherapy, I'd hesitate to recommend it, because there is NOT such good evidence that most forms, especially long-term, have benefits. If what is being contemplated is Psycho-Analytical style psychotherapy, I invariably VERY strongly recommend against it --- it costs a fortune, takes forever, and is really a form of endowment policy for the analyst. There is extraordinarily little good evidence that it is ever of any benefit to the actual patient, though it has been around for well over 100 years. I consider Analysis more a bad habit than an actual therapy.
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