Lamictal, 250 mgs: So Far, So Good

Two weeks ago, I dropped from 300 mg to 250 mg. In the past few days, I've noticed that I'm feeling a bit sharper, mentally. I've begun craving healthy food again, after several years of craving salt, fat, and sweets (normally, I'm one of those lucky people who can normally look at a plate of cookies dispassionately; not so on Lamictal). Best of all, there's been no drop in my mood whatsoever!

The downside: I've had some GI issues (constipation and gas). My muscles are stiffer. I've also been really tired, but this might be my body's way of telling me it's OK to lower my Ativan dosage as well :)

First Year on Lamictal: Efficacy and Persistent Side Effects

I started this blog one year ago today.  Since then I've been through a lot: marital problems and the loss of the two cats who'd been keeping me sane all these years.  And that's not even getting to the drugs.


Ah yes, the drugs.  I'm on a lot of things besides 300 mg of lamictal.  I'm also on 5 mg of Abilify, 70 mg of Vyvanse (for ADHD), 1.5 mg of Ativan, and (soon) 5 mg of Adderall (also for ADHD).  That's not even getting to my allergy meds.  I worry about my liver sometimes.


But this blog isn't really about the other drugs, it's about my experience with Lamictal -- how it's affected my mood, and what side effects I've had to put up with.


Lamictal has definitely stabilized my mood.  A year ago, my mood was more positive than not, but still unstable.  At 12.5 grams of lamictal, I started to feel better, but I definitely still experienced my 3pm to 7 pm trough.  I didn't start to feel stable until I hit 100 mgs.  I titrated up to 150 mgs, and did pretty well until the Autumn Equinox.


Since my depression is so sensitive to light, I went up to 200 mgs and broke out the sun lamp.  As the days continued to shorten my mood continued to destabilize.  After a few weeks at 300 mgs, I needed to start Abilify to smooth things out and to ease my depression.


I've been pretty stable since then, especially considering the deaths of my two cats in the space of two and a half months.  The cast have thrown me for a loop.  I'm sleeping more, and my motivation is shot to hell, but soon I'll be taking Adderall in an attempt to address that.


And now is the part where we address the side effects.


Lamictal seems to rewire your whole nervous system.  Like other brain meds, you might get headaches, dry mouth, dizziness, gut trouble, and sleep disturbances.  Unlike other brain meds, it affects your skin, muscles, sense of balance, and sometimes your bladder too.


Personally, I've experienced everything but the headaches (and the dreaded Stevens-Johnson syndrome) at one time or another.  Here's the breakdown:


Urinary Problems


I occasionally have trouble peeing, and this has been especially true since starting Abilify.


GI Problems


I've had occasional diarrhea and loose stools, but by far the worst thing was the severe constipation I experienced at 200 mgs.  The weird thing about this is that I had no constipation at any other dosage.


Sleep Disturbances


In the beginning, I also had severe sleep disturbances (this is by far the biggest side-effect tag on this blog). The meds gave me delayed sleep phase -- I could sleep a normal eight hours, but only between 3 am and 11 am.  Since I had been sleeping much more normal hours, this was incredibly frustrating.  This problem went away when I started using my sunlamp in the Fall, and it hasn't returned since I stopped using my sunlamp in the Spring.


Balance Problems


Before I injured my shoulder, I was lifting weights a lot.  As I recover from my injury, I'm doing yoga.  Both exercises require pretty good balance, and I notice that I sometimes have more trouble with this than I used to.  However, it's gotten better the longer I've been on my meds.


Muscle Tension


This is actually a positive side effect.  Whereas some folks notice that they're muscles are tight and sore, my muscles have loosened up significantly.  I'm much more flexible, and I don't get delayed onset muscle stiffness anywhere near what I used to get.  (Delayed onset muscle stiffness is that thing where you get stiff and sore hours to days after exercising).  Since I was lifting weights, and plan to return to lifting weights, this is pretty sweet.


Skin Problems


Aside from the Dreaded Rash of Deadly Doom, aka Stevens Johnson Syndrome, lamictal can mess with your skin in all kinds of ways.  And indeed, I've had skin issues since Day 2.  Anything that happens to my skin seems to be amplified, whether it's heat rash, sunburn, or insect bites.  This is another side effect augmented by Abilify (which actually warns you away from direct sunlight).  


To give you an example, a month ago I wrote about a sunburn that I had gotten three weeks previously.  It was still messing with my skin.  It has now been eight weeks since that sunburn, and my skin is still a weird texture, and it only stopped peeling a few weeks to.


The moral of the story is, SUNBLOCK.


The Most Important Thing I Have Learned About Lamictal


One of the posts that makes the consistent top five on this blog is the one about where to find Teva lamotrigine.  Why does this matter?


For whatever reason, lamotrigine's bioavailability can vary by something like 20%.  Isn't it great that we regulate drugs in this country?  Anyway.  If you want the same bioavailability as the brand name, you need the Teva generic.  I personally had a disastrous experience on the NorthStar version, and I know I'm not the only one.  I got the NorthStar version at the Costco Pharmacy.  As for Teva, Walgreens always carries it.  To be safe, I fill my scrips at Walgreens. 


And that pretty much wraps up my first year on lamictal.  This blog has gotten 11,538 page views since its inception a year ago.  I hope it's helped a few people along the way.

Daylight Savings Time and Fun with Sleep

If you've read much of my blog, you've read that my personal journey with my mutant mood disorder involves a downswing in the mid-afternoon.  If my meds aren't JUST RIGHT, I get severely depressed between the hours of 3 and 7.  Depressed as in crying my eyes out because of the tragedy of the human condition.  That sort of thing.

My meds have been straightened out for some time now, so this mood swing is pretty mild; I may get a little pessimistic or cranky about things, but I'm not on the floor.

Since the switch to Daylight Savings Time the mood swings have been replaced with utter exhaustion.  Many days this week I've been compelled to take a nap around 3 or 4, and I'm not generally a napper.  Don't get me wrong, this is infinitely preferable to mood swings, but it still cramps my style a bit.

The switch to DST has also messed up my sleep in another, minor way.  I can no longer wake up without an alarm at 8:30.  I was trying to wake up with an alarm, but I think I'll give that up and wake at 9:15 as I did in my pre-Soltsice all-night-vigil watch-the-sunrise says last winter.  I'd like to do another vigil, but I've been too tired to think about it recently.

And given my body and brain, it wouldn't surprise me if getting up 45 later means I don't need a two hour nap in the afternoon.

DST, Mood, Cognition, and Sleep

I love Daylight Savings Time.  Even though it doesn't actually add more daylight to the day, that extra hour in the evening does a lot for my overall well-being.  

That being said, It's a week later and I'm still a bit jet-lagged.  I'm having a bit more trouble falling asleep at night, and getting up an hour later than I would like -- 9:30 instead of 8:30.  When I have to get up at 8:30 it's a struggle.

When I stayed up all night and watched the sun rise on the Winter Solstice, I reset my clock so I was getting up without an alarm, at 8:30 every morning.  This is by far the earliest I've ever gotten up without an alarm.  In former days, I would sleep until 10 or 11 at least.

I wonder if I need to watch another sunrise to let my body reset?  Or if I have to pull another all-night vigil?

Lamictal 300 mgs: Travel, Light Therapy, and Delayed Sleep Phase

If you follow my blog, you know that lamictal messes with my sleep.  If left to myself, I would sleep from three a.m. to 11.  I'd be completely out of sync with the world.

And indeed I was out of sync for months.  This changed when I started using a blue light in the mornings.  Pretty soon I was getting up around 9:15 all by myself.  No alarm, no struggle.

Then, I went out east to visit family.  And getting up became a struggle again.  I could usually make it out of bed by 9:30 or 10, but this required an alarm at 9:15 which I would then ignore for as long as I could.

Then, I stayed up all night for my Solstice vigil, and watched the sun rise.  Suddenly, I was getting up at 8:30 ... again, without an alarm.  For a confirmed night person this was a bizarre experience.

Fast forward to last week.  I was in the Midwest, visiting family.  I dutifully did my light therapy every morning, but didn't adjust my body to the time zone.  My family are all night people, and Pacific Standard Time is two hours behind Central Standard Time, so instead of sleeping from midnight to 8:30 I slept from 2 until 10.  I should have had no problem getting back into my groove at home, right?  I hadn't changed my schedule at all.  I would go home, and my body would still be on PST.  I'd go to sleep at midnight and wake up at 8:30.

But no.  Now I'm once again struggling to get up at 9:30 or 10.

I guess the position of the sun really matters (as if I hadn't figured that out by this point).  I may have thought I was keeping my body on PST, but I was getting up when the sun was in it's 10 o'clock position.  And that was enough to hose me.

I guess I need to stay up and watch a sunrise again.  Sigh.

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.

Oh Ativan, How I Miss You; Clonopin, How I Hate You

I was a dumbass and let myself run out of Ativan.  I've been without it for two nights, and for two nights I haven't slept at all well.

Oddly, I've been able to get to sleep.  I just can't stay asleep.  I wake up every hour and a half (apparently, this corresponds to sleep cycles), feeling anxious, coming out of what feels sort of like but not quite an anxiety-tinged dream.  It's as if I'm obsessing and ruminating in my sleep in a way that I don't actually do when I'm awake (thanks, Abilify!)

When I was first prescribed Ativan a few years ago, my doctor told me that it wasn't a sleep medication per se.  It's a make-your-brain-shut-up medication.  It's supposed to quiet those thoughts that keep us from falling asleep.  These are usually anxious thoughts, but in my case they can be everything from anxious or depressive thoughts, to thoughts about my next art project, to thoughts about the space program.

Ativan is a benzodiazapene, which means that your body will build up a tolerance to it.  Maybe this is rebound anxiety from suddenly having my 1.5 mgs of Ativan cut off.   I just wish to gods that I'd been on top of the refill.  My meds supposedly shipped last Friday, so it's been four business days and I should have them tomorrow at the latest. 

For now, I'm at the point where I might have to try clonopin again or risk something seriously weird happening to my brain.  Clonopin made me feel ill after just two nights at .25 mgs (I was prescribed .5 mgs).  I managed to cut my half pill in half last time -- I wonder if I can cut my quarter pill in half again?

Clonopin .25 mgs: This Med Is No Joke

I was having trouble sleeping a few weeks ago, so my pdoc wanted to try me on something that actually makes you sleep.  Ativan (lorazepam is the generic) doesn't actually put you to sleep as such; it just makes your brain stop chattering or ruminating, so you're more relaxed, making it possible for your body to fall asleep.

So I tried it.  My scrip was for .5 mgs, but since I didn't know its effects I cut the 1 mg pill in half, and then in half again (have I mentioned how much I love having a pill cutter?) and took .25.  The next day I was a bit groggy.  "Well", I thought to myself, "sometimes these things go away after the second day.  I'll try it again tonight."

The next day I was exhausted, dizzy, and generally felt ill.  When I made my weekly farmers' market run I felt like I had to put all my mental effort into driving safely, and even then I think was taking a risk.  I had to bail on a friend's party, and we had to put off getting our Yule tree until the next day.

There are people who can take Clonopin (clonazepam) with no ill effects whatsoever.  Mo at milligrams takes it for anxiety.  A friend of mine also took it for anxiety, but only when she absolutely had to, because it put her down for a nap every time.  I learned that I am not one of these people.

A Day Without Blue Light Therapy is a Day Without End

After some trial and error with light therapy, I've finally settled on a pattern of using blue light in the morning and my sun lamp in the afternoon.  It's done a lot for my delayed sleep phase.  Since starting the blue light in the morning, I've been waking up around 9 am and falling asleep around 1 am. 

Then, this morning, something came up.  I skipped the blue light.  For just one day.  How much can it matter, right?

You will notice that the time stamp on this message is 3:30 am.  I believe I've answered the question.

Lamictal 300 mgs: Side Effect #1 -- Disturbed Sleep

A lot of people find my blog by searching on specific side effects of lamictal (or lamotrigine). This is nothing of a surprise.  On the one hand, doctors (and patients) like lamictal because for most people, the side effect profile is pretty low.  On the other hand, the side effects people do experience can be pretty weird.  These range from the deadly Stevens-Johnson rash to insomnia to weird muscle changes.  I can only tell you that lamictal, more than any other brain drug I've been on (and believe me I've been on plenty, feels like its rewired my whole nervous system.

To help out the the folks who are looking for side effect information, I've decided to do a series about the ones that have have been the most significant for me as I've titrated up from 25 mgs to 300 mgs of this medication.  I'll be working my way from the most troublesome and persistent side effects to to those that have been less difficult.  I'll note which ones the side effects were temporary or seem to be permanent.  I'll also note the dosages at which the side effects appeared or abated.

For today's post, we'll talk about the side effect that tops my tag cloud:

Side Effect #1 (Temporary): Lamictal and Disturbed Sleep

The most common sleep disturbance with lamictal is insomnia, but I experienced delayed sleep phase instead.  I could get my eight hours in, as long as I was wiling to get them in between the hours of 3 am and 11 pm.

For several months, there was absolutely nothing I could do to change this. It didn't matter if  I'd gotten only 5 hours of sleep the night before.  It didn't matter how much exercise I'd had that day.  I tried going to bed at midnight, turning off all the lights, taking deep breaths to relax ... and the weird thing is, I was relaxed.  No racing, niggling, anxious thoughts.  I was very tired and completely relaxed -- I just couldn't sleep.  I've read that this is somewhat uncommon, but can be characteristic of "lamictal insomnia".

When I started using my sunlamp in the fall the delayed sleep phase started to abate (which makes sense once I thought about it).  I can now usually fall asleep around 1 am and wake up easily -- without my alarm clock -- at 9:16.  Why 9:16?  I have no idea.  But I set my alarm clock anyway just to be safe.  When Spring comes and I don't use my lamp anymore ... who knows.

This was a pretty obnoxious side effect, because it meant my schedule was completely different from that of the normal, grown-up world.  On the plus side, I had no trouble waking up at 9 or 10 when I had to -- on the negative, I was not getting anywhere near enough sleep on these nights.  Lack of sleep is bad for mood disorders.  My mood was much, much better than it would have been without the lamictal, but I still hope this one is temporary.

For the next post in my Lamictal Side Effects series, read Post #2: Decreased Appetite

My Pharmacoepia

Just for fun the other day, I decided to compile a list of all the medications I take.  Here they are in all their scary, scary glory.

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

Midday:

• Adderall, 5 mgs  (used as an amphetamine "booster" to treat late-afternoon mood slump)

Bedtime: 

• Ativan, 1.25 mgs.  

Monthly:

• My good and dear friend, the Nuvaring (birth control)

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.

 

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, Ativan 1.25 mgs

Last week I wrote that I'd been feeling tired and lethargic.  I thought it might be titrating up to 300 mgs of lamictal.  Or maybe the time change.  Or maybe that I'd let my exercise routine slide.

A few days later I had another thought.  Maybe it was a hangover effect from the Ativan I take for sleep?  My pdoc had recently increased my dose, from 1.0 mg to 1.5 mgs.  When I first started taking it, he warned me that there could be a hangover effect.  Maybe Ativan was my problem.

The problem is that 1 mg of Ativan isn't enough to help me sleep.  1.5 mgs might be too much.  Maybe 1.25 was the answer -- but pills are 1 mg, with scoring down the middle so they can easily be broken in half.  Would it even be possible to break one half of a pill into equal halves?

The answer, I am here to tell you, is yes.  I used a pill cutter, but a sufficiently sharp knife would work.  1.25 mgs works just dandy.  I can fall asleep, and I'm not lethargic and logy the next day.  It's a good thing. 

In case you've never seen a pill cutter, here's what one looks like:

A standard pill cutter. 

 

If you take a lot of meds, you will probably need a pill cutter someday.  I got mine at Walgreens.  The one above links to Amazon.com, because I figured since I'm using the image without permission I should link it. 

LEGAL DISCLAIMER: If you buy this from my link, I will not earn any sort of royalty or commission -- I used to have an Amazon affiliate account, but last summer they shut down their program in CA over some tax dispute with the legislature.  So, no more Amazon commissions for me.