Sunday, July 31, 2011

Lamictal Day 23: Lamictal, Mood and Delayed Sleep Phase

Daily Irony Supplement: Staying up until 2 am reading John McManamy's Living Well With Depression and Bipolar Disorder. Sigh.

Since titrating up to 50 mgs of lamictal, my mood has definitely been better.  I'm not experiencing as many mood dips as I was even last week.  I had one day (Day 17) where my mood was low to neutral.  I had a low day a few days after starting lamictal too (Day 5), so maybe there's something about getting used to the dose that causes a temporary slip in mood.

On Friday, I noticed that my late-afternoon mood shift has gone in an agitated direction.  This is a change from baseline -- my tendency over the last few years experience a trough of some kind around 4 or 5 pm.  When I'm doing well, this is just slight sleepiness or trouble concentrating.  When I'm not doing well, I'm into The Pit.

The Difference Between "Sadness" and "Depression": The Pit

The players in the current backlash against brain drugs are asking a lot of very important questions that need to be asked.  Are we, as a society, medicating things that don't need to be medicated?  Are we pathologizing perfectly normal parts of the human experience, like stress over losing a job, or bereavement over losing a loved one?  Has the reliance on medications encouraged people to look for a "quick fix" to their problems??

The short version of my opinion is that we probably are.  Sometimes.  Maybe.

One of the examples of this that's often proffered is that of "normal" sadness being pathologized and medicated as a depressive mental illness.  I haven't done a ton of research on this topic.  I don't know how many people take medications, having been told they're "depressed", when they're really "sad".

I do know the difference, in my own life, between sadness (a feeling) grief (also a feeling, more painful than sadness) and depression (a hideous mental illness, which I experience as The Pit).

Saturday, July 30, 2011

Taking Lamictal (or Prozac, or Seroquel, or Whatever)? You Still Have to Deal with Your Shit.

I've recently had conversations with several friends that have me thinking about the way North Americans (and perhaps the English-speaking world in general) have come to define and treat mental illness.

One friend of mine, who has had symptoms of depression for as long as I've known him, is finally considering diagnosis and treatment -- specifically, medication.  He says he has "bad genes".  In his view, I guess, medication will correct the expression of these genes and make him less depressed.

As an example of his "bad genes", he described an incident in which his mother took off for the bar, leaving him sick with the flu and in charge of caring for his two-year-old sister.  Later in the conversation, he made repeated references to his frustration with many of his colleagues, and how he had to "do their work for them".  Hmmm.  Kind of like you had to do your parents' work for them?  How do you feel, by the way, about your mother abandoning you while you were sick?  But he's not interested in therapy.  He just needs help for his "bad genes".

Friday, July 29, 2011

John McManamy and the People's DSM: Finally, some reality.

I've been reading John McManamy's site recently.  He's the author of Living Well with Depression and Bipolar Disorder, a highly regarded book that I haven't read yet.  He's a journalist, he lives with bipolar, and he's got a pretty good grasp of brain science.

He's also got a fascinating project going called The People's DSM.  The forthcoming revision of the DSM 5 has a ton of problems.  It contradicts itself, it ignores the role that stress plays in triggering mental illness, and it generally continues the fine DSM tradition of lacking real scientific basis.

The People's DSM is an effort to create a way of categorizing and diagnosing mental illness based on the actual realities of -- get this -- people who have actual mental illnesses.

Do Psychotic People Really Make Tinfoil Hats?

During my own psychotic depressive episode, I found myself rockin' the sterotype and heading straight for the tinfoil.  Well, aluminum foil, actually; tinfoil hasn't been made since WWII, because aluminum is cheaper and doesn't leave a tinny aftertaste in food.  But somehow "aluminum foil hat" doesn't sound the same.  Even the first section of the Wikipedia article on tin foil hats says that they're hats made of aluminum foil.

I love Wikipedia.  It turns out that there's a clear origin to the tinfoil hat stereotype: a story by Julian Huxley (brother to Aldus Huxley, author of Brave New World) called "The Tissue Culture King", in which the protagonist discovers that caps made of metal foil can can be used to block telepathy.  As wikipedia notes, aluminum foil can used to make something like a Faraday cage that blocks radio waves.

Thursday, July 28, 2011

MCBT Homework and ADHD

I'm taking this class in mindfulness-based cognitive behavioral therapy.  I feel like it's helpful -- I certainly feel calmer after meditating -- but on the other hand, the class started just after I began lamictal.  I can't tell what's the drug and what's the meditation.

The class requires homework, and I'm having trouble remembering to do it.  Maybe blogging about it will help.

Day 20, 50 mgs: GI issues, sleep, and ... feeling cheerful?

Yesterday I was having some GI issues -- gassy, bloated, and constipated.  Also some heartburn.  I've been a bit constipated since going up to 50 mgs, but I don't know if the other issues were med related or not.  I didn't eat anything out of the ordinary.

My mood is definitely improving.  The pattern seems to be that I start the morning slightly low in terms of energy and mood (by which I mean I feel more "meh" than "neutral".  Put THAT in your DSM and smoke it).  Throughout the day, my mood rises, until by late afternoon or evening I sometimes feel downright cheerful.  For a cynical bastard such as myself, this is a bit alarming.

Tuesday, July 26, 2011

Dear Cat, You Are NOT HELPING

I'm making some progress in the sleep department.  I turned out the light at 1:30 or so.  I hadn't quite fallen asleep when I got up to use the bathroom around 2:45.  I needed to be up at 10.  7+ hours of sleep isn't too bad.

Except that my cat CC (also a writer!) decided to be be a jerk.  My morning was like this:

CC doesn't want to be fed.  I learned a long time ago that if I want to sleep any later than 4:30 am, the cats get fed at night.  No, she just wants attention.  Either that, or she just takes pleasure in knowing that she can destroy my sleep, and then take the warm spot when I have to get up.

Today's Dose of Awesome: The Origin of the "Tin Foil Hat"

It occurred to me to wonder how foil came to be associated with paranoia and delusions (as indeed, it played a role in my own psychotic depressive episode).  So I looked it up on Wikipedia.  They have a short article about the foil hat meme, including the following sentence:

The effectiveness of tin foil hats is disputable,[citation needed]
For. The. Win.

Monday, July 25, 2011

Day 17: MCBT, Mood, Lamictal, and sleep

I hung out with a friend for awhile today, had lunch, talked of this and that.  She's been on lamictal/lamotrigine for years for bipolar disorder.  It's worked for her, no problems.  It helps to hear that from someone who's actually lived it.

I felt present and engaged, but a little low.  Not depressed, not even sad, just the low side of neutral.  I'm OK with that, I'm just noting it so I know it.  I suspect it's because it was gray and a bit chilly outside.

I accomplished what I feel is my first really "successful" meditation today.  The first meditation we did was  "body scan" version in which the recorded instructions were to take deep breaths ... focus on your breath ... now focus on your right foot ... etc.  That one was done lying down.  The one I did today was a sitting meditation, and seemed to incorporate more general sensory awareness.  The instructions told us to tune in to any sounds I heard, what the cushion under me felt like, whether whether my body was tense, and, of course, my breath.  For some reason, I felt like I had more "permission" than I usually do to watch my thoughts wander away, and then bring them back.

Sunday, July 24, 2011

More Reflections on the Frist Two Weeks of Lamictal/lamotrigine

Yesterday I got off on a tangent about lamictal and its effect on my muscles (to make a long story short, some people experience sore muscles on this med, but I find my muscles are much MUCH less sore, and I would probably think this was a Good Thing even if I didn't lift weights).  As I was going to bed last night it occurred to me that I should write up a list of all the side effects I've experienced since starting this med, broken down by category.


  • Rash of tiny red pin-pricks after working out on Day 2.  Checked with my doctor and verified that it wasn't The Lamictal Rash.  It went away by the next day, but reappeared after my next workout.  Again, it disappeared by the following morning.  It hasn't been back since.
  • Dry skin and mild acne.  I'd say my skin has been slightly dryer than normal, but in the last few days I've developed some mild acne on my forehead.
  • Dermatitis, especially at bedtime.  I don't know if this has to do with changing clothes or what, but I've noticed that my skin seems to itch the most when I change into my pajamas.  There's no redness or anything, just random itchiness. 
  • Increased sensitivity to bug bites.  There are many fewer mosquitoes in California than there are in my home state of Minnesota.  I almost never get bitten here.  But in the last few weeks I've noticed several mosquito bites, and they're much redder and larger than usual. 


  • Mild insomnia.  This has been worse since I stayed up late to watch the shuttle's last landing ever.  My body seems to want to set itself on a 3 am to 11 am clock.
  • Overall quality of sleep is improved.  Before I started Lamictal/lamotrigine, I would wake up several times a night, usually when my cat was being a jerk.  Now, once I fall asleep, I stay asleep.  It's kind of nice.


  • Dry mouth.  This can be managed by drinking lots of water.  No big.
  • Lack of appetite.  This seems worse in the morning, and can cause problems if I don't get enough to eat before working out.  I solved the problem this week by drinking a protein shake with fruit and dandelion greens before my workout (yeah, it was about as tasty as it sounds).
  • Nausea: Mild and occasional. 
  • Constipation:  Noticeable when I first started Lamictal/lamotrigine.  Then it went away.  Came back when I titrated up to 50 mgs.
  • Bloating:  Mild to moderate, and seems to vary related to nothing in particular. 


  • Word-finding problems and brain blocks.  This only happened on one day.  Then it was gone.

  • Changed reaction to alcohol.  I seem to be somewhat more tolerant, feeling no effects whatsoever from a single drink (usually I feel some but not much).  A single drink before bedtime will ensure that I sleep deeply and long.  When I have more than one drink, I seem to experience only the slowed thought and reaction time, and none of the buzzy, tipsy, euphoric feelings.  Since I know damn well that alcohol blunts the effects of meds, and increases depression, this is probably a good thing. 

So that's me.  What has your experience been with lamictal?  Have the side effects been bothersome or negligible?

More About Psychotic Depression

There doesn't seem to be a ton of information out there regarding psychotic depression.  What there is doesn't seem to be too helpful.  I'd really like to find out what the course of the illness is (or usually is) so I can understand what happened to me and intervene before it happens again.

The tricky thing about what happened to me last winter is that my mood had not been getting seriously worse.  At least, not most of the time; it was much worse than usual, but only in the late afternoon and early evening.  This is usually a low point for me in terms of energy, if not mood, so it wasn't too surprising.  I also have seasonal issues, so it wasn't surprising that my mood was worse in general.

When I presented my psychotic symptoms to my doctor, he said that I was surprisingly functional (possibly one of the reasons I avoided the hospital?), because most psychotic depressive symptoms happen in patients who are so depressed that they're having trouble getting out of bed and caring for themselves.  And indeed, during the morning, early afternoon, and late evening -- and for that matter even during my crashes -- I could move around and do things.  In fact, I felt like doing things.  I needed to move around; I wanted to distract myself.

Saturday, July 23, 2011

Day 15: Up to 50 mgs, and Reflections on the First Two Weeks.

Today I titrated up to 50 mgs of lamictal.

I've been at 25 mgs for two weeks.  Before starting lamictal, I was definitely experiencing mild mood swings, mostly between anxiety and the kind of sadness that tells me I'm not in The Black Pit of Depression yet, but I could find myself circling it if I'm not careful.  The lasting cognitive effects and "flattening" I'd experienced on Lexapro had finally abated.

Since starting lamictal, my mood has stabilized and improved somewhat, and so far there doesn't seem to be any negative effects on my attention, motivation, or focus (thank the gods!).  The only cognitive effect was some word-finding issues, and drawing a visual blank regarding a recipe I'd made many times before, but I only experienced this on one particular day.

Friday, July 22, 2011

Lamictal Day 13: Sleep and Booze

I was expecting yesterday to be weird, after staying up late to watch the Shuttle land the night before (you can read my ramblings about that here if you're so inclined).  And it was.  I was tired when I got up after about 6 and a half hours of sleep (I can manage on 8, but do best with 9).  I took my meds, felt less tired, and then throughout the day I felt ... odd.  My mood was pretty good, but it felt fragile somehow.  My mind was racing a lot.

I've found that when I stay up late one night and shortchange myself on sleep, that I often don't feel like going to sleep the next night.  This is true no matter how tired I might have been during the day.  It's as if my body hits a post-dinnertime energy surge, and I'm not tired at all anymore, not even remotely tired, and I can't even think about going to bed and trying to sleep.

This happens frequently when I visit my family.  Except for my father, we're all night owls.  We don't see each other often because my brother and I live in a different state (different time zones even) than my parents and my sister.  When we get together, we tend to decide that starting a game of Trivial Pursuit at 12:30 am is a good idea.

It doesn't happen as much when I'm at home, but it happened last night.  I had planned to go to bed at a decent hour (for me, that's midnight or so), but I wasn't tired and I found myself chatting with a friend until 1:30 am.  At that point, since I was hungry (and still not sleepy!) I decided to pour a shot of vodka into my Trader Joe's mango lassi.  My experience so far with lamictal and alcohol is that my tolerance seems to be increased slightly, but that even one drink makes me sleep like a baby.

I still didn't even try to fall asleep until 3 am.  Then, I slept clear through until 12:30 this afternoon.  It's kind of nice having the power to  give myself a long, sound sleep with one measly drink.

Some Thoughts About MCBT and ADHD

As I've mentioned previously, I'm taking a class in mindfulness-based cognitive behavioral therapy. I've learned a couple of things so far:

  1. My mood crashes in the couple of hours before class.  I'm not sure why this is.  Am I thinking about my depression, and how little control I have over it?  Am I thinking about meditation, how hard it is, and how I don't feel like I'm "doing it right"?  Am I thinking about all the homework I've skipped?
  2. Meditation is hard.
  3. Focusing on my breath, which is supposed to be calming, makes me anxious.  Your heart rate naturally increases when you breathe in, so maybe I'm just interpreting the physiological response as an emotional response?

Thursday, July 21, 2011

Definitely the Lamictal Stupids, and they're different than ADHD

Over at the CrazyMeds anti-convulsant page, Jared Poole talks about "the stupids" as a common side effect of anti-epileptic drugs.  Yesterday I wrote about having trouble finding the words for some of the art materials I've used for years.  Last night I had another such experience.

I was making dinner.  It's a dish I've been making for years and it's very simple.  First you throw some garlic in the food processor and grind it up finely.  Then you ... um ...

It wasn't just that I couldn't find the words.  When words are "on the tip of my tongue" my visual cortex often kicks in and supplies me with an image of the object, which I recognize and can then name.  This was as if there was a hole where these ideas should be.

Detour Into Low Earth Orbit

At the risk of playing merry havoc with my mood, I'm staying up an extra few hours to watch the landing of the space shuttle Atlantis, otherwise known as STS135.  I've got NASA's UStream feed going in another tab.  I'm joined by 8700 viewers and counting.

I went through the astronaut phase when I was a kid.  I was inspired when Sally Ride went into space, and I wanted to break ground like her -- I was going to be the first woman on the moon, or maybe even mars!  That's right, my childhood dreams actually didn't include being mentally ill, and surviving only because my husband has health insurance [cue Debby Downer music].

Wednesday, July 20, 2011

Day 11: Word-finding

One of the odder side effects of Lamictal is difficulty with "word-finding".  It's kind of like it sounds -- you're looking for a common, everyday word, and you just can't think of what it is.

I experienced a little bit of that this morning.  My art student broke a palette knife, and remarked that it was a good thing they were the cheap plastic ones.  I mentioned that I've never broken a palette knife, but I suspected that it was partly due to the fact that I don't use ... don't use ... that type of paint ... whatever this type of paint is called, that comes out of the tube ... .  Argh.  What I'm trying to say is, I use liquid acrylics, and it takes less work to mix them.

The phrase I was looking for was "heavy body acrylics".  It's the acrylic paint that comes in tubes.  As a painter and art teacher, I know the phrase, and I've known it for years.  It does not represent some new and complex vocabulary.

It happened a few times this morning (ironically enough, once when the word I was looking for was "coherence"), but the "heavy body acrylics" incident stands out.  It wasn't like I was trying to find the "right" word, and it wasn't like the word was "on the tip of my tongue".  The words simply were not there.  I stared at the paint tube, trying to remember what that type of paint was called, and just couldn't.  "Heavy body acrylics" finally came to me as I was driving home.

It will be interesting to see if this is just a verbal phenomenon, or if it happens with writing too.

Tuesday, July 19, 2011

Day 10: exercise, appetite, and Lamictal

Lamictal/lamotrigine is supposed to be a "weight neutral" drug.  Unlike many mood stabilizers or antipsychotics, it doesn't mess with your metabolism and it doesn't make you crave carbs (thank you, Lexapro!).

The downside, at least for me, at least so far, is that it seems to suppress my appetite.  This is bad in two ways.

The first is that maintaining steady blood sugar is key to managing any mood disorder.  Whether you have depression or bipolar disorder, remembering to eat regular, healthy meals is going to keep you from crashing.  The same is true of ADHD, which I also have -- if I forget to eat, my attention suffers, making it hard for me to remember to eat, etc.

Monday, July 18, 2011

What IS Psychotic Depression, Anyway?

It's something I didn't know existed until it happened to me.

Psychotic depression is also called "Major Depressive Disorder with Psychotic Features" or "Major Depression with Psychotic Features.  When psychosis occurs in major depression, the patient is fully aware that what they're experiencing -- be it a hallucination or paranoia or delusion -- is not founded in reality.  With other psychotic breaks, such as those that occur with manic phases of bipolar illness or with schizophrenia, the patient believes their delusion.

Psychotic depression often requires hospitalization and treatment with anti-psychotics as well as antidepressants.  It can be hard to diagnose.  Like I said, we're fully aware that our thoughts are irrational.  Feelings of shame, which are bad enough in depression to begin with, often lead psychotic depressives to hide what's going on.  There is a high risk of suicide with psychotic depression.

Being Broke Sucks

I've been unable to work since last December (and before that I was unemployed ... so I guess I've been unable even to LOOK for work since December).  It sucks.  I'm married, with an employed spouse, so I'm not starving ... but on the other hand, I'm struggling to stay within my monthly budget.  It doesn't help that my meds cost $150 a month.  And that's with insurance.

My parents and my aunt gave me some money for my birthday last month.  In the past, I've used such money to invest in my art work, or treat myself to something.  This year, I used it to pay my shrink.

Now THAT is depressing.

Sunday, July 17, 2011

Day 7 on Lamictal: Mini-meltdown

On Friday (day 7 of my new drug regimen) I had a meltdown that sort of caught me by surprise.

One of my closest friends has returned from a year-long graduate school program on the East Coast.  I missed my friend a lot, and was looking forward to her being a regular part of my life again.  On Friday I learned that she will not be returning home permanently, or at least not yet; she'll be in town for awhile, and then will be driving back to the East Coast for she's-not-sure-how-long.  It's something she strongly feels the need to do.

When I learned this I started crying and couldn't stop.  I'd had an intuition that something was up with my friend.  Now, it had been proven right.  She's leaving.  Like so many of the friends I've made in my adult life, since moving to California ... people just don't seem to stay here.  Everyone abandons me!  Wah!

Friday, July 15, 2011

The rash is back, but it's still not THE rash

In my second post, I wrote about a benign rash I noticed while I was enjoying my post-workout soak.  Checked it with my pdoc, all was well.  Yesterday I noticed it again -- also post-workout.  I'm guessing that it's related to heat and sweat generated during my lifting session.

I couldn't get a good picture of it, but the photo it most resembles can be found here.  The difference, I guess, is that it wasn't on my eyelids, and did not result from near-asphyxiation.

It's looking like intermittent sweat rash may just be something I get to live with on this med.

Muscle stiffness, teeth grinding and lamictal/lamotrigine

A lot of people have reported muscle stiffness when taking Lamictal/lamotrigine.  Jared Poole of the inestimable CrazyMeds describes them this way:

... everything from just a twinge in your neck or back to full-body aches that make you wonder if you were possessed by some spirit that made you participate in a triathalon the day before and have no memory of it.

This had me concerned.  As I've mentioned before, I'm a weight lifter, and DOMS (delayed-onset muscle stiffness) was already a problem for me.

Wonder of wonders; lamotrigine (so far) seems to be improving my general muscle stiffness!  Yay!  DOMS is nowhere near as bad as it used to be.  Using the foam roller after working out doesn't have be swearing like a sailor because of the pain.  

But the real miracle is that my bruxism seems to be significantly diminished, maybe even gone entirely.  I've ground my teeth for as long as I can remember.  Getting my wisdom teeth removed helped somewhat, but my dentist still prescribed a mouth guard to wear at night.  Being on SSRI's and stimulants didn't help this at all, of course, but I've ground my teeth even when I've been taking no drugs for my brain.  

I can't tell you how nice it is to wake up without my jaw clenched.

Thursday, July 14, 2011

Lamictal and Booze

You're not supposed to mix Lamictal and booze.  Alcohol, we are told, keeps these meds from working.  It makes our condition worse.  No booze for you!

I decided to have a beer last night with dinner.  I'm just a rebel, what can I say.

The result was that the dermatitis effects of the lamotrigine seemed worse -- I was kind of itchy.  Still, the rash that quietly showed up on Day 2 remains much diminished ... with the exception of a spot on my thighs where the seam of my jeans seems to rub on it.

Also, I slept REALLY well, but too long (10 hours instead of 8-9).

My mood though?  Fine.  Just fine, thanks.

Wednesday, July 13, 2011

Lamictal Day 5: Ups and Downs, and Mindfulness CBT

Yesterday was my first really good day.  My mood was in good shape, without my usual low point in the late afternoon.  I don't know how much of this, if any of it, is due to the cup of coffee I had in the morning.  I've learned that it's generally better for me to avoid caffeine, for reasons of both mood and attention, but sometimes when it's right there in the coffee pot ... I just can't help myself.  I had a bit of a headache in the evening, but otherwise no side effects.

Today was not so good.  After starting out in a pretty good place, I was feeling sad by early afternoon.  By late afternoon I was almost weepy.  I felt myself questioning the lamotrigine, wondering if it was going to stop working, or if I was going to have to wait another eight or ten weeks until I reach a "therapeutic" dose.

Things picked up in the evening, when I had my first class in Mindfulness Cognitive Behavioral Training for depression prevention.  After our first meditation exercise, I felt discernibly better. After the second one, I actually felt relaxed and cheerful.  In spite of this, I had another mild headache on my way home from the class (about eight pm or so).  Oh well.

I wish I didn't have to be so concerned about this med.  But when the side effects can include a deadly skin rash or aseptic meningitis, it's hard not to be hypervigilant.

Monday, July 11, 2011

Lamictal Day 3: 25 mgs

So far, so good.  My mood is definitely better today than it has been in pretty much forever.  Technically it's too soon for me to be feeling any effects from the lamotrigine, but whatever.  We're all different, right?  And I've proven myself to be pretty sensitive to medications in the past.

Yesterday I had a nervous moment when I got out of the shower and saw that my skin was covered in tiny red pin-prick looking things.  They weren't bumpy, they didn't itch or hurt, and I wasn't running a fever.  They also looked nothing like the rashes I saw when I googled "lamictal rash".  I dropped my doctor an email just to be safe, and he wrote back to say that what I was describing was benign, but to keep him posted of ANY skin changes.

Sunday, July 10, 2011

Lamictal Day 2: 25 mgs

My doctor tells me that Teva is actually the only generic that has the same bioavailability as name brand Lamictal, so I took 25 mgs today.  So far, so good.

Yesterday my mood slumped during the late afternoon/early evening, which is typical, but the slump seemed worse than usual.  After I ate dinner I felt fine, so perhaps it was just low blood sugar.

I also had a bit of a scare last night when my chest and belly started itching.  I scratched the itch, and it turned red, and I thought, is this the dreaded rash?  On the other hand, sometimes I just get dermatitis, and the itchiness was within the realm of normal for me.  I figured I'd give it until this morning before worrying about it.  Lo and behold, the rash was gone an hour after I stopped scratching it.

My mouth is pretty dry, and it tastes like something died in it sometimes, but that's what water and gum are for, right?

Saturday, July 9, 2011

My First Day On lamictal/lamotrigine: 12.5 mgs

When my psychiatrist prescribed lamictal, he went down a list of Important Things to Know.  The most important is how to deal with the dreaded Lamictal Rash (which can be fatal, which is bad):

  1. If a skin rash occurs with a fever, go to the emergency room immediately (and)
  2. Call me
He warned me about the need to titrate slowly, as he was directing me, to avoid the dreaded Lamictal Rash.  And, he said, if the generic manufacturer was switched, I needed to call him.  Not all generics are equal.  Some have more bioavailability.  Lamotrigine manufactured by Teva, he says, can be equivalent to the next highest dosage.

I was supposed to start at 25 mgs, but when I looked at the bottle, there it was -- made by Teva.  I decided to break the pill in half (it's scored, which means that this is OK) and start at 12.5 mgs and leave a message for my doctor letting him know that.  I really need this medication to work out for me, so I don't want to run any risk of The Rash, and it seems best to play it safe.

I took the med about 5 hours ago. At the time I took it, my cognition had returned to normal, and my mood, though fluctuating, was more or less positive.

MoodElevated, calm
Cognition Focus, motivation, concentration normal
Sleepiness tolerable
Headache none
Nausea none
Abdominal Pain none
Back Pain none
Dry Skin none
Acne none
Tremor none
Blurred Vision none
Lack of Coordination none
Muscle Painnone
Dry Mouth Noticeable