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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10547
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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I am currently taking 250 mg topomax , 500 mg Metaformin ,

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I am currently taking 250 mg topomax , 500 mg Metaformin , 300 mg. Wellbutrin in the morning. In the evening I take 250 mg. topomax & 500 mg Metaformin . I am prescribed the Metaformin for PCOS ( a hormonal condition in women) and the wellbutrin for depression. I take the topomax because I binge eat.

I have suffered from binge eating, over exercising, bad relationships, anger and depression throughout my life. I had never taken any antidepressants until last summer & I started with the Wellbutrin prescribed by my family doctor. Then I added topomax after participating in thereapy with a psychologist to address my binge eating. At first the topomax was amazing. . . .my moods & impulse eating where not out of control. Now, 8 months later. . . I'm having problems again. My psychologist thinks that my actions are characteristic of borderline personality disorder and should be treated differently than just depression. I have since made an appointment with a psychiatrist, but the appointment is not until the November 8th. After researching bpd, I noticed that 2 common medications suggested as a foundation for impulse control and mood swings are lamactil & abilify.

After being so verbose. . . .here's my question. . . Would it be ok to add lamactil to the medications I am already taking to stabilize my moods swings and impulse control? I've read that both of these work well as a partner to Wellbutrin and I know my topomax works, it just is not enough anymore. It probably never was. I called my gen doctor today & she will get back to me on Tuesday, but sometimes I'm not sure if she really knows.

( I'm also in the process of ending a 5 year relationship with an alcoholic boyfriend & starting a stressful new job that has me working 7 days a week :)

Dr. Z. :

Hello I believe I can help with your concerns

Dr. Z. :

I am so sorry that you may be suffering from the symptoms of borderline personality disorder (BPD), I can imagine how distressing this may be for you.

Dr. Z. :

You can add the Lamictal to your current medication regimen, but usually Lamictal is a treatment for severe depression, resistant depression, or depression associated with Bipolar Disorder. While it will help with some low moods associated with BPD, it will not help with the anxiety and anger component associated with BPD.

Dr. Z. :

Here is a link showing the no interactions between the Topamax, Wellbutrin, and Lamictal for you

Customer: Oh thank u for the link!
Customer: I really do not have a lot of anger
Customer: I just have mood swings that are dramatic
Customer: I am able to keep them in check. Within myself
Dr. Z. :

The abilify can help with the anger outbursts and the mood swings, but there is a risk associated with it when you use it in combination with the Wellbutrin

Customer: But my coping mechanism is the binging and then I over exercise. Unfortunately now I am depressed and in bed and mad at myself for not exercising and mad at myself for eating too much. The anger is always directed at myself.
Customer: I thought the abilify makes people gain weight?
Dr. Z. :

Well the abilify can be at a low dose to still be beneficial and can be used still with the wellbutrin. The abilify can cause weight gain, but if it is at a low dose it most likely will not cause this and this and your dosage of the Wellbutrin actually promotes weight loss.

Customer: So you would recommend the abilify over the lamactil?
Customer: Sorry I typed that twice. . .i did not mean to
Dr. Z. :

Its okay no worries. The topamax is already a mood stabilizer, like the Lamictal, so if you want to go on the Lamictal, I would suggest removing the Topamax. Then you can take a low dose of Abiligy (5mg) with the wellbutrin, and lamictal if that is the direction you want to go. You can take both the Lamictal and Abilify at the same time if you like.

Dr. Z. :

Taking the abilify and wellbutrin together puts you at a risk for Serotonin Syndrome, but this is negated if you are taking a low dose of the Abilify.

Customer: Topomax keeps my weight down....could I keep topomax & add low dose abilify & keep Wellbutrin or am I being too concerned about the weight ( it's a large part of my bpd)
Customer: I am confident that once I get into my psychiatrist's office & start the therapy, my dependence on the medication will lessen, but right now I just want to get out of bed & go running again & stop being so mean to myself.
Dr. Z. :

No you are not being too concerned with your weight. Well Topamax already increases your body temperature and sweating, and this can increase with the Abilify, which can lead to heat stroke in some individuals when these medications are combined. You can still use the medications together, but you have to be weary of heat stroke and drink plenty of fluids before exercising.

Dr. Z. :

Here is a link explaining the heat stroke concern I mentioned and the Serotonin Syndrome as well with the Wellbutrin and Abilify

Dr. Z. :

I understand why you want that and you definitely deserve feeling better. The DBT book you are using should also be beneficial to you as well as this is the best therapy modality for treating BPD.

Dr. Z. :

I would also recommend this DBT self-help website too

Customer: I will definitely read the information on all of the links. You are very kind. I am closer to the answers I have been searching for . I think I have enough information now. You should go help someone else now.
Customer: Thank you!!!!!
Dr. Z. :

Anytime, I am always happy to help.

Dr. Z. :

My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime.

Dr. Z and 2 other Mental Health Specialists are ready to help you

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