Lamitcal + Abilify = You Really Need Sunblock

Lamictal, as we all know, can really mess with your skin.  In rare cases, it can mess with your skin so badly that it can kill you.  But those are rare cases.  Most of us just notice that our skin is more easily irritated than before.

The warnings on Abilify caution you to avoid direct sunlight.  Seriously.

So what happens when you fail to take your meds into account and spend an afternoon in the sun without sunblock, which would be a bad idea anyway because you inherited the pasty skin of your Irish ancestors? What happens is that you wind up with a sunburn that flakes for weeks afterwards.

Strangely enough, my sunburn wasn't bad enough to hurt.  My skin just stayed really red for almost a week.  Three weeks later, my skin is still flaking slightly.  In pre-lamictal/abilify days, this whole process would have taken about a week.

So, kids, if you're on either of these meds, and all the more so on both, wear that sunblock.

Lamictal 300 mgs, Abilify 5 mgs: Bruxism is Back

When I first started lamictal I was overjoyed to find that I no longer ground my teeth.  After a few months on Abilify, the problems seems to have returned.  It's not as bad as when I was on zoloft, but it's still there.

Strangely (or maybe not), the problem really got noticeable when I switched to an ergonomic pillow for my neck.  My neck is pretty screwed up.  It will take any excuse it needs to tighten up and impinge the nerves in my arms and hands.  Hence the pillow.

The pillow seems to be helping my neck at the expense of my jaws.  I wake up, and my neck feels great -- but my jaws are clenched old school, and I can feel my teeth grinding.  When I was visiting my family last week this was even worse.  My mother uses these stiff damn pillows on the guest bed, which meant that both my neck and my jaws were screwed up.

I guess it's back to the mouth guard for me.

Lamictal 300 mgs: Too Much Booze

The past several months have been pretty stressful for me.  There's been the relationship drama, the wondering whether I'd go crazy again, and then there's been some unexpected veterinary visits for both my cats totaling about $600.  One of the cats was simple -- yeast infection in her ears.

The other cat?  She has a weird collection of symptoms.  She's off her food, which is really concerning; there's a reason her nickname is "Piglet".  She's lost some weight.  A few weeks ago she was dribbling urine, but that was diagnosed as a UTI and cleared up.  She's having digestive issues.  They did a full blood panel and urinalysis.  It didn't really show anything wrong, except perhaps mild kidney dysfunction.

And she's still not eating.  Cancer can't be ruled out until a full x-ray and ultrasound is performed, and that would cost me $600 to $800.  I don't know whether I would do that test or not given that my next step would be palliative care.  Everyone I know who's treated a cat for cancer says it's traumatic for everyone involved.

Or, maybe my cat, who's pushing 17 pretty hard, is just showing her age.

That's the background information that explains why I've been drinking too much.

Forgot to Take My Meds: The World at a Distance

This morning I was meeting a friend for brunch.  I don't normally meet people for brunch, which means that this was an alteration of my morning routine.  When my routine is altered, I forget to do things.  Such as, I forget to take the medications that help me to remember what my morning routine is.

In my case, of course, it's not just a question of forgetting my Vyvanse, which is bad enough.  It also meant forgetting to take my lamictal and my Abilify.  I didn't realize I'd done this until I'd been on the road for half an hour, when I started to wonder why I was feeling so out of it.  By the time I was done with brunch, I felt like everything was a hundred feet away.

As the day wore on, I also felt sad and anxious.  When I got home from brunch it was early afternoon.  I doled out my meds and put them in the little bowl that I use to make sure I have all of them.  Then I forgot about them for another few hours.

Then I removed the Vyvanse, since I'm sure not to sleep well if I take that at 5 pm, and took my lamictal, my Abilify, and my allergy meds.  I'm feeling better already; calmer, more stable, and less sad.  Maybe lamictal just doesn't have much of a half-life.

Lamictal Side Effect #4: Weird Food Cravings

In my continuing series on weird lamictal side effects, I will today be writing about a particularly odd one.  It's related to the second most persistant and annoying side effect, loss of appetite; but this one has to do with the kinds of foods I do have an appetite for.

In short, they're high in salt and fat.

Since I started taking this stuff I've been into really weird omelets.  And when I say weird, I mean weird: last summer I making omelets out of a raw tomato sauce that had tuna fish, olives, capers, and arugula in it.  Salt and fat.  But I can eat this kind of thing when my usual sedate breakfast of yogurt and gluten-free bread just seems unappetizing.

I'd think I was pregnant, only I know with 100% certainty that I'm not.

Previous posts in the series include #1: Delayed Sleep Phase; #2: Loss of Appetite; and #3: Digestive Issues.

Lamictal 300 mgs, Abilify 5 mgs: I Feel Like Myself Again

Last year at this time, though I didn't realize it, I was working incredibly hard -- and all the time -- to manage my psychotic depression.  My mental energy went to reigning in bizarre thoughts, or to distracting myself by fixating on an art project, or by obsessively cleaning the house.  It was exhausting.  The antipsychotic medication helped a lot, but it didn't fix it.

This year, I've been on lamictal, and the difference is like night and day (which is good, since my delusions were about photons).  I was able to see just how hard I had to work last year to keep the crazy at bay, and how this year, I simply didn't have to put in that effort.  Yay lamictal!

Nonetheless, I was still pretty moody by early December.  Overall my mood was better.  I no longer had to listen to cheerful, energetic music to keep myself from becoming untethered.  Sometimes I could even listen to a sad song without totally losing it.

Oh Yeah, My Mood Action Plan

My experience the other night made me remember that I'd created a Mood Action Plan back in the day.  I've printed it up and posted it above my desk/studio table.  I've already acted on some of them -- namely those that deal with my daily mood crashes:

• Troughs or crashes in mood between the times of 4 and 8 pm become more frequent
• Troughs or crashes in mood between the times of 4 and 8 pm become worse (tearfulness, paranoia about relationships, pessimism running to despair)
• Troughs or crashes in mood lengthen beyond the 4 to 8 pm range

All three of these symptoms are occurring, a fact to which I have alerted my pdoc (which was action number 1 on my Plan). We're trying an Adderall booster in the early afternoon, but it's proving to be problematic for my sleep if I don't get in some vigorous exercise during the day.  And I do mean "vigorous". It has to be weight training -- going for a run don't cut it.

Lamictal 300 mgs: Depression and Some Thanksgiving Gratitude

I complain a lot in this blog.  Its intended purpose was to be a mood diary, and while it is that, it's also become a place for me to vent about my life.  I write here to clarify my thoughts and feelings -- but also to bitch about -- my meds, my mental illness, my learning disabilities, and the impact they have on every single area of my life.

Today I've decided to do something else.  In honor of Thanksgiving weekend, I've decided to list the things I'm grateful for.  I've also decided to make this a weekly feature of my blog.  I whine a lot.  In fairness, the last year of my life has really sucked.  But there are also plenty of good things about my life that I should acknowledge more often. 

Besides, gratitude has been shown to protect against stress and depression, so it will even do me some good.  Ironically, given a post I wrote a few days ago, I'd like to express gratitude for my medications.  For all my issues with Big Pharma, for all my concerns about the long-term side effects they might have, the simple fact is that my meds dramatically improve the quality of my life. 

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.

Lamictal 300 mgs: My First Really Bad Day

Yesterday sucked.

It began with a bad dream.  If you don't want to read my whole long post about it, suffice it to say that the dream involved betrayal, abandonment, rejection, and a package tour.  Horrible.  It affected me more than my dreams usually do, probably because it was so obviously about my deepest fears vis a vis my current situation, and I began my day slightly depressed.

When I hit my usual trough of 4 pm, I felt much, much worse.  Lately my troughs have been pretty mild.  I'll feel a little down, or a little less energetic, or both; however, yesterday was the first day in a long time that I've landed in the depths of despair.

I don't know what could account for it.  I'd been up late the night before, and therefore up early the next day, but I've done that before without suffering such consequences.  I'd skipped my sunlamp the night before -- this seems like a pretty likely factor.

Lamictal 200 mgs: Day 1

Today is my first day on 200 mgs of lamictal.  I only took it an hour ago, but one thing of note is that I'm already feeling pretty anxious.

Of course, I have external reasons to feel anxious.  My relationship is going through a very rough patch, our first counseling session went very poorly, and I'm honestly afraid to go back.  In addition to that, I'll be visiting my grandmother in a few weeks, and that's bound to be emotionally challenging.  It doesn't help that, since I'm using frequent flyer points to get out there, I have limited availability regarding flight times.  I was supposed to coordinate with my sister about arrival times, but I can't get ahold of her.  I'm afraid that if I wait too long, I won't be able to get the tickets at all, but if I go ahead and book the flights, I'll be inconveniencing everyone by arriving at a weird time.

Hmmm.  Having written that, I think maybe I'm over-thinking this.  Arriving at an inconvenient time would hardly be a disaster.  It's not like I'll miss a wedding or something.

I'm also worried about going crazy again as the days grow ever shorter.

It's not helping that the weather is being damned weird today.  It went from lovely and sunny to dark and raining to lovely and sunny again.  This would be typical weather in the upper Midwest, where I grew up, but for my part of NorCal, it's really not.  I don't know why, but I've always been uneasy when the weather does weird things.  What with climate change and everything, I guess I'll be dealing with a lot of that.

Lamictal Day 39: 125 mgs? Oops.

I'm supposed to be taking 75 mgs of lamictal.  Today I accidentally took 125.  For a drug which can have serious consequences if too much is taken too soon, this could have been a serious mistake.  So far though, the only side effect seems to be some mild tachycardia, which went away after I meditated.

How did I manage to screw this up?  Well, in order to replace the disastrous NorthStar lamotrigine, a prescription which my psychiatrist had written for 25 mg pills, I needed a different denomination of pills in order for my scrip to be covered by insurance.  Lamictal and lamotrigine apparently don't come in a 50 mg denomination (no, that would be easy).  My pdoc had to write the scrip for 100 mgs, and then I was supposed to break them in half, and cut the remaining piece in half, and thus achieve 75 mgs.  Kind of confusing.  To help explain, here's a picture of Teva lamotrigine:

As you can see, they're scored down the middle, so it's pretty easy to break them in half and get 50 mgs. To break one of those halves in half takes a sharp knife, but it's doable.  I know this because I did it yesterday.  Then I put the half of a half tablet back into the medicine bottle.

Lamictal Week 3: GI Stuff, Sleep, Alcohol, Skin, and Cognition

Week 3, my first week at 50 mgs of lamictal, continued to improve my mood, but also brought increased side effects.

Gastro-intestinal stuff:  For much of the week I've been slightly bloated, gassy, and constipated.  This has been mildly annoying but livable.

Skin stuff:  Still no sign of The Rash.  My initial pin-prick rash has not reappeared, but I took last week off from working out, so I might not have seen it anyway.  I continue to experience simultaneous dry skin and acne, but this could be worsening because my period is due.

My skin is definitely more sensitive than it used to be.  If I open the oven door to remove something, I really feel the heat -- and as it subsides, it itches quite a bit.  Then it's gone.  I've also noticed that it hurts more than it used to when my cat decides to wash my face.  That sandpaper tongue is murder!  My skin is also somewhat red afterward.

Alcohol: Yesterday I drank most of a bottle of wine in the evening.

As I was falling asleep, I realized that I've gone through 3 bottles of wine this week -- some of that was cooking, granted, but that accounts for maybe 80% of one of those bottles.

I probably went through three bottles of wine in the entire previous month before last week.

As I wrote at the end of last week, one side effect of the lamictal seems to be that alcohol doesn't give me as much in the way of tipsy-euphoric feelings as it used to, but I still get the slowed-down feelings.  I thought last week that this would continue to influence me not to drink. And yet, here I am, drinking.  Why?  Well, that brings us to ...

Sleep:  The insomnia I wrote about last week has continued.  I still sleep better, once I fall asleep, but I feel more and more as if this med is trying to give me a delayed sleep phase.

Only yesterday I was writing about my brain's tendency to race at night, and the need to find a way to wind down at night.  It would seem that 3 bottles of wine was attempt to do exactly this.  The scary thing is that I was not exactly aware that I was doing this while I was doing it.

The improved nightly routine I wrote about yesterday is looking more and more imperative.  I'm not sure what to do yet, but I need to do something.

Cognition:  In spite of consuming rather a lot of alcohol last night, I woke up this morning and was immediately able to hold a coherent conversation with my husband.

I am not a morning person.

Morning people are weirdos.  Everyone else will know that the brain is not meant to be functioning immediately after waking.  It requires at least fifteen minutes to communicate in monosyllables, and then a good breakfast, in order to be merely sluggish.  People who wake up ready to discuss the debt crisis are just ... abnormal.

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.

SKIN:

• 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. 

SLEEP:

• 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.

GI TRACT:

• 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. 

COGNITIVE ISSUES:

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

MISCELLANEOUS:

• 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?

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.

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!