Wednesday, November 23, 2011

Lamictal! Adderall! Ativan! The Musical!

In yesterdays post I wrote about feeling tied to my sunlamp for most of the day.  This is particularly bad during the late afternoon during my usual 4pm to 8 pm slump.  It's seriously cramping my style.

I saw my pdoc recently, and he was concerned about the slump.  He wants to try other things before raising the dose of lamictal.  It which seems fair enough. 300 mgs of lamictal is as high as they usually go to treat mood disorders; 400 mgs and upwards puts you into anti-convulsant territory.

So his suggestion is to take 5 mgs of Adderall XR in the afternoon.  Great.  Another drug.  I wasn't already feeling like my pee could be sold as a street drug that "will really make you trip, man!  This stuff is primo!"

Hmmm.  Maybe there's a profit to be had there ...

Yesterday was the first time I tried the Adderall booster.  It definitely helped my mood, but I slept like crap last night.  I was exhausted, and hope to sleep like a baby.  As I sometimes (OK, all too frequently) do these days, I had two drinks to make damn sure I would sleep well.
Last spring, I was put on Adderall boosters in a desperate effort to get me out of my Lexapro coma.  I would wake up at 10 or 10:30, take my meds, feel OK for a few hours, and then feel exhausted and lethargic by 1 pm.  This, in spite of my 70 mgs of Vyvanse I took in the morning ... though that wasn't a real surprise, since when I was on Lexapro the Vyvanse didn't seem to be working at all.

When it became clear that I wasn't recovering from the Lexapro, in spite having been off it for several weeks, my pdoc prescribed 5 mgs of Adderall XR, one to be taken in the morning, one to be taken around 12:30 to avoid the 1 pm slump.  It helped, slowly.  I began taking the boosters in mid-May, and was able to stop taking them at the end of June.

However, since that time, I've forgotten some key things about Adderall:
  • It decreases my alcohol tolerance.  Lamictal had increased it, so I was pretty surprised when my speech started slurring after 2 drinks.
  • It interferes with my sleep.  Now that I'm casting my memory back, I've realized that a soothing sequence of yoga poses had been part of my nightly routine while I was taking Adderall. 
  • Booze + Adderall REALLY messes with my sleep.  Last night I was exhausted.  I was in bed by 11:30, which is a rare occurrence unless I'm sick.  
    • I took my 1.25 mgs of Ativan.  
    • I felt sleepy and relaxed, but no sleep was forthcoming.
    • At 12:30 I took another .25 mgs of Ativan, but no sleep was forthcoming.
    • At 1:45 I gave up and took another whole 1 mg tablet of Ativan.
    • At 2:30 I tried my calming yoga routine.
    • At 3:30 I happened to see the clock and realized that I'd finally been asleep.
    • At 8:30 I woke up to pee and reset my alarm for 10.
This is not sustainable, but then, neither is my mood or my reliance on my sunlamp.  Today I'll try taking the Adderall at 1 or 1:30 instead of 2 pm.  At 5 mgs, Adderall is supposed to last only 3 or 4 hours, but yesterday it lasted me clear through the afternoon and evening.  I suspect this has something to do with the Vyvance I'm already on, which lasts 14 hours.  And probably drug interactions with the Lamictal.

As for sleep, I guess it's back to yoga plus 1.25 or 1.5 mgs of Ativan, instead of last night's 2.5 mgs.  I can't afford to be taking too much of that shit, and I can't afford not to be sleeping either.

Just for fun, I decided to compile a list of the medications I take daily:

Morning cocktail:
  • Lamictal, 300 mgs (mood stabilizer)
  • Vyvanse, 70 mgs (long-release amphetamine to treat ADD)
  • Claritin, 10 mgs (anti-histamine)
  • Nasacort, 2 puffs each nostril (corticosteroid to keep my sinuses and ears from inflaming)
  • Singulair (leukotriene inhibitor to prevent asthma symptoms
  • Adderall, 5 mgs  (used as an amphetamine "booster" to treat late-afternoon mood slump)
As Needed:
  • Q-var (corticosteroid for wheezy asthma -- I pretty much have this for emergencies)
  • Abuterol (corticosteroid for acute asthma attack -- I need this even less often than the Q-var)
  • Phenlyephrine (decongestant that is MY BEST FRIEND, because I can't tolerate Sudafed; for the longest time there were no other decongestant options out there, but phenylephrine was released because you can't cook meth from it.  Thanks, crystal meth epidemic!)
  • Advil (If you don't know what this is, you live under a rock and probably don't have internet anyway)
  • Booze (for fun.)
My poor liver.  My poor, poor liver.


  1. From reading this post, and your last one, I can see the bind you are in... You have a solution (sunlamp) that has the side effect of limiting your life (you have to stay in that room!) and this side effect could actually make your mood worse, because you can't get out and do what you want to do! I can see why your doctor thought an additional stimulant med might be helpful - but it's not that simple, is it? I think of it like I can drink caffeinated tea after dinner to feel better, but then I have to take something to sleep! Take one med to counteract another med and so on, and soon you don't know what's doing what! I wonder if you've tried Melatonin at all? Low dose (300mcg) might be helpful but who knows... It is supposed to help for people who take Ritalin, I think if you take it when you're coming off of the Ritalin, it's supposed to make things smoother. Hmm, if I can think of any other helpful suggestions I'll let you know :) Happy Thanksgiving to you and best wishes!

  2. Oh never mind on the melatonin comment - forgot that you aren't supposed to take it if you have asthma!

  3. Yup. I can't remember whether I wrote about it here, or your blog, or not at all ... or maybe you caught it yourself. But it bears repeating:

    If you have asthma, melatonin is contraindicated. It will make your asthma worse. My own asthma is pretty much under control, and has been for several years, but when I tried melatonin I got really wheezy. At first I didn't know why -- then it occurred to me to read the melatonin bottle, and right there in bold letters, it said not to take it if you have asthma.

  4. What is your diagnosis? I have BP2, anxiety (hereditary), and ADD because I am overfocused, not inattentive. It sounds a lot like what I have been through. Thank you for the insight and the humor.


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