Side Effect #7: Lamictal and Exercise

Can you really call "exercise" a side effect?


Well, probably not.  But many of the side effects I've talked about so far -- particulalry sleep problems, appetite problems, and balance problems -- can combine to make exercise a challenge.  As I've mentioned before, I lift weights three days a week, and run intervals on my off days.  That is, I used to.

Problem #1:  Balance.  Easily Managed.

The balance problems have been a challenge from the get go, but I've been able to manage them.  I don't have a problem when I'm running, or when I'm lifting with both legs, but one-legged deadlifts and lunges have been a real challenge.  I have to concentrate a lot to keep from wobbling and falling over.

Problem #2 and #3:  Sleep and Appetite.  Not so easily managed.

But thanks to the sleep and appetite problems, I've had to take a six week break from exercising because of lamictal.

This came about because I had noticed that I was making no progress with my weight training.  I couldn't move up to heavier weights; in fact, I was having more and more trouble with the weight I was already lifting.  And push-ups?  I wasn't getting any better.  I was getting worse -- a lot worse.  The most troubling thing of all was that my back was beginning to bother me.

I just couldn't figure out what was going on.  I was lifting three days a week like I was supposed to.  I know I have decent form.  So why wasn't I making progress?  Why did it seem like I might even be risking injury?

Finally I trundled over to my workout book, The New Rules of Lifting For Women, which rocks.  I finally found a passage that explained everything: if you're not making progress, you're either drinking too much, eating too little, or sleeping too little.

Well, at the time I was doing more self-medication than I should have been, but I'd never noticed much of a problem with booze and exercise before that.  However.  I knew damn well I wasn't sleeping well enough or long enough.  As for eating?  I guess that a serving of yogurt and a slice of bread, consumed over the course of several hours, are not enough fuel to grow stronger muscles.  Who knew?

Well, I should have.

Solutions to Sleep and Appetite Problems: Blue Light, and Nutritional Hacks.

I fixed my sleep problems about a six weeks ago thanks to my blue light.  To solve my appetite problems, I've spent this week eating salty, fatty, proteiny things for breakfast, because my body wants them.  Alternately, I've been putting my yogurt in a blender with some water,  and doing the same thing with my greens.  Ive found that it's easier to drink my breakfast than to eat it.

From the beginning I've found that my appetite picks up around 4 pm (which is interesting since this is the time of my afternoon mood slump).  But without having a decent breakfast and lunch, there's simply no way to continue my exercise routine.  Here's hoping my solutions work.

Side Effect #5:  Bonus!  No More Delayed Onset Muscle Stiffness (DOMS)


My muscles have always been tight.  Ever since I joined the swim team in middle school, various coaches and physical therapists have been trying to loosen them up.  Even after two years of pretty intensive physical therapy, during which I learned to stretch properly and use a foam roller, they were still generally tight.  DOMS was just a fact of my life.  After workouts, everything would hurt every time I moved.

Most people who experience muscular side effects from lamictal experience soreness and tight muscles.  Given my history, I was concerned.  But I got lucky.  Since starting lamictal, I have more flexibility than I ever have before, and I no longer experience DOMS.  It's not that I don't get knots in my muscles; I certainly do.  It's just that I can use a foam roller without swearing in such a fashion as to make my longshoreman ancestors proud.

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.

300 mgs of Lamictal, Week 1: From Delayed Sleep Phase into Somnolence

I am now up to 300 mgs of lamictal, what I hope will be a therapeutic dose.  I know that higher doses are used to treat epilepsy -- lamictal was first developed as a anti-convulsant -- but I have no idea whether there are problems if they're used to treat mood disorders.

Fortunately, my mood seems to be pretty good so far.  On the other hand, my mood has improved every time I've titrated up, only to sink again as the days continue to get shorter.  On the other other hand, my daily dip has seemed to even out somewhat, which I figure I can take as a good sign.

My first week at 300 has also changed my side effects dramatically.  My delayed sleep phase is simply gone -- I get sleepy at 11:30, fall asleep around midnight, and usually wake up around 9.  On the other hand, sometimes I sleep too much, until 10 or 10:30.  Nine hours of sleep is what I need to function well.  Ten hours is unusual.

The GI effects that I bitched about so much have also vanished completely.  They came on suddenly at 150 mgs, and continued through 200 and 250.  At 300 they just disappeared.  Yay!

Lamictal Day 67: Muscle Weirdness, Balance Issues, Appetite Returning?

I seem to be regaining my appetite.  I finished breakfast in under an hour today!  And it wasn't even hard work to eat.  My pdoc is keeping me at 150 mgs for a month, and then titrating up to 200 mgs, so I should have some normalization of appetite for a little while at least.

As I wrote in an early post, muscle stiffness is a common side effect of lamictal.  This has something to do with its anti-convulsant properties, but I'm not sure exactly what.  As with all brain drugs, though, paradoxical effects are not uncommon (remember those black box suicide warnings on antidepressant medications?).  I've been blessed with one of these -- my muscles are more relaxed and loose than they've ever been in my life.

The odd thing about this is that I can still develop huge knots in my muscles.  I've recently started to do interval training on the days when I'm not weightlifting.  For me, this means running on pavement.  Since my route is basically a circle of several blocks, and the sidewalk slopes down toward the street, there's some kind of stress being put on the muscles in my left leg.  I have a truly huge knot in my left calf, and another in my left IT band (that's the outer side of your leg, running from your hip to your knee, and keeps you standing upright like the homo sapiens that you are).

Day 61, 150 mgs of Lamictal: Muscle Weakness?

Yesterday I lifted weights, and noticed that I couldn't lift as much as usual.

This isn't uncommon for people doing strength training.  Sometimes there are days when you're just off.  And maybe I'm being paranoid -- just because I'm on this drug doesn't mean that everything that happens is a side effect of this drug.

I first noticed the feeling of weakness when I was carrying my weights out to the deck where I usually work out.  I can typically one-hand my case of barbells (about 40 lbs), but I found myself using both hands to carry it.  Given that fact, I decided not to up the weight on my front squats, but at least I could get through them.  I had to take the weight down for all of my single-leg exercises, like lunges and step-ups.

Day 41, 100 mgs of Lamictal: Feeling Better About Life

I think I may be hitting a sweet spot where the lamictal dosage is concerned.  It's been tough to track my moods in some ways because I've had a fair bit of stress since I started the titration.  The situation with my grandmother is stressful, and my mood definitely took a hit from that.  Then there's the whole deal with my marriage.

I'm feeling more optimistic about that today.  The last few days have been pretty hard.  At many points I found myself obsessing over the difficult times my husband and I have had.  I wondered if we've ever been truly happy together.  I wondered why my husband even wants to be with me, when my learning disabilities, my ADHD, and my mood disorder clearly cause him so many problems.  It's been nearly ten years since I've done this sort of thing.

I guess the mindfulness training must be paying off, because at some point I realized that I was basically thinking "depressive thoughts" about my husband and me.  My depression was causing me to undervalue the good times we've had and the good things about our relationship.  Basically, instead of thinking depressive thoughts about myself -- I'm no good, I'll never be successful, etc. -- I was thinking those thoughts about my marriage.

100 mgs of Lamictal: Sleep, Appetite, Exercise

I titrated up to 100 mgs of lamictal yesterday, and not a moment too soon.

I've been sleeping better than I have been for the last several days.  I've been falling asleep by 2 am, sleeping through the night, and waking up (with my alarm) around 10:00.  Waking up seems harder than it has been.  My body wants to sleep until 11.  I don't know if this is fatigue from getting back into my weight lifting routine, or if I'm not sleeping as well as I think I am, or if the med is just making me sleep longer.

My appetite in the mornings is even worse than it's been.  This morning I got up at ten, fell asleep on the couch, woke up again at 11, and have been trying to finish breakfast off and on ever since.  It's now 3 pm.  Eating in the morning just feels like a chore.

The appetite thing is impacting my exercise (and probably my sleep too).  When you're doing strength training, you need to eat in order to build your muscles.  If you don't eat, you make yourself vulnerable to injury, and you also feel tired.  And in my case, if I don't exercise enough, my sleep phase gets even farther out of whack.

I've also been feeling dizzy and out of it today.  Could be the lamictal -- both of those are potential side effects -- or it could be the lack of food.

Day 40: Lamictal, dizziness, and exercise

Last week I noticed something odd when I was working out.  Every time I went to do lunges of any sort, I had an unusually hard time keeping my balance.  This was true of both my dominant and non-dominant legs (I'm right handed, therefore my left leg is also dominant, and stronger).  I was wobbling all over the place, and all of the stabilizing muscles in my working leg were working overtime.

When I started doing lunges three years ago, I was about 50 lbs heavier and recovering from a knee injury, and I could still keep my balance better than this.

I'm noticing balance issues even when I'm not working out.  It's not like dizziness or vertigo.  I get that with ear infections, and it's kind of like the floor is moving up and down.  This is more like a milder and more prolonged version of standing up too quickly.  I notice it when I'm standing or walking, but I have less of an issue remaining upright when I can use both legs.

This seems to be related to the dose increase.  Last week I was ready to blame it on the inferior generic lamotrigine, but this week I'm back on the Teva, and it's still happening.  I hope to gods it goes away soon, because my adductor muscles are getting overworked.  My knee is also annoyed, and none of this is helping my left hamstring.

So although I am experiencing more muscle pain than I have been, it's related to straining to keep my balance.  Delayed-onset muscle stiffness is still blissfully mild, when it's there at all.  The only other change in side effects I've noticed is some dermatitis on my upper arms that seems particularly bad around bedtime.  Here's hoping the balance issues improve soon.