![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by porkpiehat on July 28, 2016, at 14:52:11
I think I want to try a real AD again. I've switched back to name brand lamictal and the flu symptoms and back pain are every day now. First it feels like it works so much better than the generic with mood and motivation and social interactions, but then I got all hypomanic or mixed or agitated, and began having weird seizures or panic attacks the second I fall asleep. four days of lithium settled the manic symptoms down, but I'm back to the unmotivated/anhedonic state even I'm not constantly thinking about suicide.
Defensive/hypervigilant thinking is increased; interpersonal anxiety continues. I'm also getting the terrible cognitive effects where I keep forgetting stuff and I can't navigate a simple when page. Plus the flu symptoms and nighttime disturbances. Ugh.
I've been on it for 10 years. Can't get below 100 mgs without a total crash.
Most of the SSRI's actually work but almost too well. Lamictal with the SSRI's make the cognitive symptoms three times worse.
Anyone get off lamictal/replace lamictal/or add anything to make this better?
Are there MOAI's or TCA's that are better at the depression/distraction/anxiety that go along with a possible dx of complicated trauma or BPII?
Posted by Tabitha on July 28, 2016, at 16:16:39
In reply to Time to ditch lamictal finally?, posted by porkpiehat on July 28, 2016, at 14:52:11
It's interesting that you note SSRI+lamictal created bad cognitive problems. I noticed my thinking got a lot clearer after dropping SNRI which was in combo with lamictal.
I'm curious how high your lamictal dose is?
Sorry I don't really have suggestions for you. Have only used SSRI and SNRI. Planning to stay on 200mg lamictal for now.
Posted by SLS on July 28, 2016, at 17:43:33
In reply to Time to ditch lamictal finally?, posted by porkpiehat on July 28, 2016, at 14:52:11
> I think I want to try a real AD again. I've switched back to name brand lamictal and the flu symptoms and back pain are every day now. First it feels like it works so much better than the generic with mood and motivation and social interactions, but then I got all hypomanic or mixed or agitated, and began having weird seizures or panic attacks the second I fall asleep. four days of lithium settled the manic symptoms down, but I'm back to the unmotivated/anhedonic state even I'm not constantly thinking about suicide.
>
> Defensive/hypervigilant thinking is increased; interpersonal anxiety continues. I'm also getting the terrible cognitive effects where I keep forgetting stuff and I can't navigate a simple when page. Plus the flu symptoms and nighttime disturbances. Ugh.
>
> I've been on it for 10 years. Can't get below 100 mgs without a total crash.
>
> Most of the SSRI's actually work but almost too well. Lamictal with the SSRI's make the cognitive symptoms three times worse.
>
> Anyone get off lamictal/replace lamictal/or add anything to make this better?
>
> Are there MOAI's or TCA's that are better at the depression/distraction/anxiety that go along with a possible dx of complicated trauma or BPII?Before moving on, could you describe what you experience as "mania" and "mixed-states"? How do you appear to others?
- Scott
Posted by porkpiehat on July 28, 2016, at 20:51:57
In reply to Re: Time to ditch lamictal finally? » porkpiehat, posted by SLS on July 28, 2016, at 17:43:33
Scott:
The way I was feeling was first good mood, motivated, then driven and hyperactive and feeling like I had too much ideas and energy to fit inside me, and reaaallly irritable about stupid things. The first night I was up until 3 am writing assignments I had been dreading, with no desire for sleep. A couple of nights I felt so ragey and energized i needed a few klonopin and beers. I told off my new pdoc and almost threatened her. After the short lithium trial it calmed down.
before the irritability part struck I was actually pretty personable and not obsessively fearing everyone, and excited about people and things; then too excited.
I'm really worried now about the ongoing flu symptoms and the the sleep things. My dad thinks he was neurologically damaged by lamictal and these are starting to feel more like neurological events than the panic attacks/night terrors. I take 2mgs prazosin at night now and I stopped having the traditional panic attacks/dissociation The problem is falling asleep.
Posted by SLS on July 29, 2016, at 9:24:16
In reply to Re: Time to ditch lamictal finally? » SLS, posted by porkpiehat on July 28, 2016, at 20:51:57
Your experience appears to be a great deal like a hypomanic episode. However, there is a chance that your experience is not a manifestation of bipolar disorder, despite the overlap in symptoms. For exammple, some people experience psychotic reactions to prednisone. This happened to my grandmother. She never displayed any kind of mental illness previously. Officially, bipolar disorder can be diagnosed when a drug produces mania, but only if the mania persists after the culprit drug is withdrawn.
I'm glad that lithium is helping. For bipolar disorder, I have seen a combination of Lamictal + Trileptal effectively treat mania and depression at the same time. It brought the person into years of remission. He discontinued his Trileptal due to financial concerns, and became floridly manic mixed-state very quickly. He began gambling and swore he won a trillion dollars on the Internet. His doctor gave him samples of Saphris. Within three days, the mania subsided, and I was able to have a conversation with him.
The NIMH likes Lamictal + lithium for bipolar disorder.
At what dosage does Lamictal begin to affect you negatively? I found that the Teva brand of generic lamotrigine did not work as well as Lamictal. However, adjusting the dosage upwards helped. Perhaps you would respond better to Lamictal by using a dosage that is lower than that you find effective with the generic. If not, then you really need to find a substitute that has antidepressant properties.
What dosage of lithium are you taking? How are you reacting to it? Is there anything you don't like?
Are you taking an antidepressant? I forget.
Which antidepressants did you like best?
If it has been established that you have bipolar disorder, you might profit from a combination of a mood-stabilizer and an antidepressant. Some people respond better to SSRIs, and some better to SNRIs. You might consider opting for a treatment regime that includes an atypical antipsychotic with antidepressant properties. You may not need a mood stabilizer or lithium. I do better with Abilify, it but can produce anxiety, insomnia, and restlessness early in treatment. These sometimes disappear completely. They did with me. Reluxti is related to Abilify chemically, but is supposedly less apt to produce akathisia-like symptoms. Saphris is a interesting drug. I have seen it work wonders in a case of schizoaffective disorder, bipolar type. It acts as an antidepressant for her. It is being used in combination with Navane. Interestingly, my doctor says that Saphris is helpful in cases where paranoia is involved. Geodon is unpredictable, but can act as an antidepressant.
So...
If a reduced dosage of Lamictal proves inadequate, I would consider adding something to address mania at the higher Lamictal doasge. You could add:
1. An anticonvulsant mood stabilizer. I prefer Trileptal in your case.
or
2. An atypical antipsychotic with antidepressant properties.
or
3. Lithium at anti-manic / mood stabilizing dosages.For me, Abilify has provided antidepressant effects. Additionally, I have not had a manic episode since beginning it, despite taking drugs that often produce mania. It goes well with the Lamictal 300 mg/day I am taking. I don't do well without Lamictal. However, I never had a manic reaction to it. Lamictal might be unworkable for you.
If Lamictal + lithium doesn't work, develop a plan. I'm sure you can come up with a variety of them.
For instance:
Move forward only if the previous treatment failed.
1. Continue Lamictal at lower dosage.
2. Add Trileptal.
3. Increase dosage of Lamictal.
3. Add an atypical antipsychotic with antidepressant properties.
4. Discontinue Lamictal.
5. Add antidepressant.
6. Discontinue Trileptal.
7. Switch antidepressants.What are the ideas that you and your doctor were considering?
Hang in there!
- Scott
Posted by porkpiehat on July 29, 2016, at 11:31:41
In reply to Re: Time to ditch lamictal finally? » porkpiehat, posted by SLS on July 29, 2016, at 9:24:16
Wow this is quite the comprehensive response!
I only did the lithium for three days. When I felt the underlying agitation from the lamictal diminish (I'm guessing it was an adjustment issue) I stopped the lithium. I think it was only 150 mgs. It was sedating/a little blunting, and I was starting to forget things.
However when I came off I continued to forget things, and lose the ability to navigate websites and finish sentences. These cognitive issues were the big drawback when I started, along with the flu symptoms. I was hoping that was a result of the combination with celexa and it wouldn't happen this time now that I'm off it.
I am very med sensitive and tend to feel manic and impulsive on Prozac/Celexa; and get what I think are dysphoric manias on Zoloft and Buspar. These should point toward Bipolar, no? However the symptoms stop with the med stoppage.
I think the med sensitivity and the personality changes might be splitting/defensive mechanisms from complex trauma, which we know runs parallel to BP symptoms.
With regards to the lamictal dose, I would maybe continue up to 200mgs but I remember the cognitive issues just get worse with higher dosage. The flu feelings and sleep disturbances will also have to go away.
I am a little scared about getting back on a serotonergic AD but I think it will be the only thing to address the obsessive feelings of guilt/persecution/social anxiety, plus give me a little zest for life again.
I did notice when I stopped the Celexa that I felt much calmer in my head, that reading and concentrating became a little easier. Outbursts of anger (after the washout) became less frequent, and I felt much less desparate regarding my state of mind and some situations. I think the reading and concentrating had more to do with the mixture of celexa and lamictal, because I could read fine on 40 mgs of celexa before the lamictal, just no drive to accomplish anything.
The atypicals feel unpredictable to me and I only know how they feel mixed with other things like celexa, lamictal, and (earlier) Serzone.
I felt incredibly dissociated/depersonalized on Risperdal and then super agitated. It was with Serzone.
Seroquel (with celexa and lamictal) made me less obsessive/vigilant/meta over my interpersonal relationships for a while and then just cognitively stupid and tired. With just lamictal I felt really out of it and confused. This is all at 50 mgs or so.
Latuda (with celexa and lamictal) made reading and task avoidance better, but gave me terrible nightmares and felt very emotionally detached.
with just the lamictal I got an immediate seratonin boost on the Latuda, followed by some pretty serious rage and agitation. Metacognitions were less but the nighttime panic/dissociation was bad. this is about 20 mgs, maybe 10?
I am trying to get into grad school. So treating my mood at the expensive of cognitive functioning isn't really an option.
If I'm not truly bi-polar (still a question), do I need to be mucking around with the seizure meds as the only options? I've heard trileptal is good but causes mid-day sedation.
Posted by porkpiehat on August 2, 2016, at 13:33:10
In reply to Re: Time to ditch lamictal finally? » SLS, posted by porkpiehat on July 29, 2016, at 11:31:41
So FWIT when I switched back to brand name lamictal I started feeling:
-fluey
-hypomanic
-initially happier, more productive, and less anxious
-heart palpitations
-some kind of seizure or panic the second before I fell asleep that would continue for an hour or two. The part was the worse.I switched back to the generic which does little for the depression, and the next night I stopped having the night seizure. I was able to successfully fall asleep. The heart palpitations and flu symptoms are gone too.
Anyone have any notion why this would happen? Am I suffering brain damage from lamictal?
Posted by SLS on August 2, 2016, at 15:04:48
In reply to FWIT...lamictal was causing nighttime seizures, posted by porkpiehat on August 2, 2016, at 13:33:10
> So FWIT when I switched back to brand name lamictal I started feeling:
>
> -fluey
> -hypomanic
> -initially happier, more productive, and less anxious
> -heart palpitations
> -some kind of seizure or panic the second before I fell asleep that would continue for an hour or two. The part was the worse.
>
> I switched back to the generic which does little for the depression, and the next night I stopped having the night seizure. I was able to successfully fall asleep. The heart palpitations and flu symptoms are gone too.
>
> Anyone have any notion why this would happen? Am I suffering brain damage from lamictal?There is nothing that I have encountered that would lead me to believe that you have damaged your brain from taking Lamictal. However, Lamictal or generic lamotrigine seem not to be a good drug for you. I found brand-name Lamictal better than the two generics I have tried. I wouldn't be surprised if your using a higher dosage of the generic would produce those negative side effects you get on name brand.
It sounds to me like you could use an antidepressant, but combined with an antimanic mood stabilizer or antipsychotic with antidepressant properties.
Perhaps you can make a short list of what you have tried already and what were the results.
- Scott
Posted by porkpiehat on August 2, 2016, at 21:08:44
In reply to Re: FWIT...lamictal was causing nighttime seizures » porkpiehat, posted by SLS on August 2, 2016, at 15:04:48
> It sounds to me like you could use an antidepressant, but combined with an antimanic mood stabilizer or antipsychotic with antidepressant properties.
>
> Perhaps you can make a short list of what you have tried already and what were the results.
>
>
Scott: If you click above today's post in this thread you'll see a quick overview of what I've tried for AP's and you're tagged in it
Posted by SLS on August 3, 2016, at 0:11:42
In reply to Re: FWIT...lamictal was causing nighttime seizures » SLS, posted by porkpiehat on August 2, 2016, at 21:08:44
> > It sounds to me like you could use an antidepressant, but combined with an antimanic mood stabilizer or antipsychotic with antidepressant properties.
> >
> > Perhaps you can make a short list of what you have tried already and what were the results.
> >
> >
> Scott: If you click above today's post in this thread you'll see a quick overview of what I've tried for AP's and you're tagged in itOkay. Thanks. My memory is terrible.
- Scott
Posted by porkpiehat on August 3, 2016, at 10:36:23
In reply to Re: FWIT...lamictal was causing nighttime seizures » porkpiehat, posted by SLS on August 3, 2016, at 0:11:42
Scott i'd love to know what your impressions are of my experience with the regimens I listed.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.