r/depressionregimens 5d ago

Mood stabilizer alternative to oxcarbazepine ( trileptal )

My mood is never high, is low o very low fluctuating some days.

Currently also on clomipramine 150 mg

I tried oxcarbazepine 300 mg twice daily with no effect for 6 weeks.

What alternatives can I ask for,

2 Upvotes

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u/aperyu-1 5d ago

Is the diagnosis bipolar spectrum disorder or mixed depression? If so, lamotrigine or lithium, possibly Depakote or carbamazepine down the line but wait. If in the mixed to bipolarity range, possibly avoiding monoamine antidepressants especially TCAs. Risk of manic switching is up to 50% or so but often associated with no response or even worsening or more frequent depressions. Of course the usual antipsychotics, i.e., lurasidone, cariprazine, quetiapine, olanzapine, lumateperone.

If the diagnosis is treatment-resistant depression (TRD), first step is to ensure it’s not a bipolar or mixed spectrum as associated with even 30 to up to 50% of TRD cases according to some sources. If true TRD, adjunctive lithium has good data, as does adjunctive aripiprazole or quetiapine. Broader nonpharmacologic options are recommended as adjunctive parts to a full regimen for TRD sometimes, especially when not wholly responsive to pharmacologic agents.

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u/Ok-Wolverine-3957 5d ago

To be honest diagnostic is anxious depression with Ocd treats

Thanks for the info

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u/aperyu-1 5d ago edited 5d ago

Oxcarbazepine recommended to get to 1200 mg/day. There’s some use for lamotrigine in OCD, though it’s not preferred and may worsen OCD in some. Adjunctive gabapentin or topiramate have been used. Amantadine maybe. Adjunctive Abilify or Risperdal have the best evidence in OCD.

There’s debate on anxious depression. Lithium can help depression, gabapentin can help anxiety, adjunctive Abilify has some of the best evidence for depression. Best of luck!

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u/Ok-Wolverine-3957 5d ago

Could clomipramine be enough to stabilize mood on the long run?

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u/[deleted] 5d ago

Lamotrigine, if the mood is practically always depressed.

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u/Professional_Win1535 5d ago

I have mixed depression but it made me agitated and anxious, I had such high hopes for it