Lamictal 300: Today's Weird Omelet

I should be honest here; they're not so much omelets as egg scrambles.  I don't have the patience to cook eggs to the proper consistency, put in the filling, and flip the damn thing over.  Too much work.

Anyway.  Today's weird omelet: dal with garlic shiitake mushrooms.

Yup.

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: Side Effect #2 -- Decreased Appetite, Weird Cravings

Lamictal and Appetite:

Continuing my series of the most noticeable side effects of lamictal, today's topic is loss of appetite.  I've written 15 posts about this.  I've found it to be less disruptive than the sleep issues, but at least those could be addressed with my blue light.  Loss of appetite is far more persistent.

I started having problems with my appetite on July 19th.  It's come and gone over the months, but mostly they've come and stayed.  Right now, thanks to the Abilify, they've camped out on my lawn.

The appetite problems manifest primarily as difficulty eating breakfast.  Not only am I not hungry,but food seems completely unappealing.  My usual breakfast, which I've enjoyed for a few years now -- yogurt with dark cocoa stirred into it, a gluten-free carb (either bread or a waffle), and some salad greens -- often seems yucky to me.  Breakfast often sits there for four or five hours as I slowly pick at it.

When I do eat breakfast in a somewhat normal fashion, it's because I'm eating dinner foods.  Specifically, salty, fatty dinner foods.  Green chile and cheese tamales from the farmers market.  Weird omelets.

By 3:30 or 4, I'm ravenous.  Unfortunately, this is my depressive time, and my breakfast problems haven't helped my mood any.  On the other hand, I'm hungry enough that I to make up my calories in the afternoon and evening, so at least I'm getting enough of them.

Since this problem was beginning to abate after I'd been on 150 mgs for a month, I suspect it will disappear again once I stop taking Abilify.

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 150 mgs: An Overview of Mood and Side Effects

Today is my last day on 150 mgs of lamictal.  I've been at this dosage for a month, and tomorrow I'll be going up to 200 mgs.  This month has been difficult for several reasons -- life stress, mood stress, and side effect stress.  I guess I hit the trifecta.  Lucky me.

Being on 150 mgs has definitely improved my mood, but my mood suffered with the shift into autumn, so I started using my sunlamp.  In spite of this, during my third week on this dosage, I experienced more 4 to 8 pm troughs than I had in the previous two weeks.  The fourth week was much better.  What was different during the fourth week?  I had my period.

Yeah, I know that's not the stereotypical way for things to go.  And strictly speaking I don't have periods because I'm on hormonal birth control.  But this past week has been my "off week".  For some reason, hormonal birth control (this includes both The Pill and the NuvaRing, which is awesome) interferes with lamictal.  When you take your "off" week you have more of the med in your system.

Anyhoo.  My mood has not been high enough or stable enough for me to stay at 150 mgs.  It suffered with the waning light, it suffers when it's cloudy, and today, gods help me, it's raining.  The light will continue to wane, and my mood along with it.  When daylight savings time ends, it will suddenly be getting dark an hour earlier, and that's the point at which I started to crash last year.  In light of that (haha!), I'll be asking my doctor if I can ultimately go up to 300 mgs.  I just don't want to take any chances.

But the most remarkable thing about titrating up to 150 mgs has been the side effects.  Whooboy, the side effects.

Lamictal 150 mgs: Sleep Returning to (Almost) Normal, Dry Mouth Interfering

The good news is that after nearly twelve weeks on this medication, my delayed sleep phase seems to be fading.  I have to credit this to my sunlamp.  Last week, with the official onset of autumn, I started using my sunlamp for half an hour in the morning and half an hour around sunset (sometimes an hour if I'm feeling particularly low).  I've also been trying to stay in bright light until 8 or 8:30, as per the instructions of my brain doctor.

Within two days of starting the sunlamp, I began to wake up on my own around 9:30.  I had been waking up at 11, but only with the help of my alarm clock, and it was sometimes a struggle.  At night, I'd been staying up until 3 am.  Most of the time I simply couldn't fall asleep until then, even if I was exhausted.

The last several nights I've been turning the light out at 1 am, but I haven't really been able to sleep until 2 or 2:30.  I think that much of this is due to the hellish dry mouth I'm enjoying, courtesy of lamictal, vyvanse (a stimulant), all of my allergy meds, and my sunlamp.  I'm drinking what possibly amounts to two gallons of water a day.  This is (I think) four times the "eight cups of water" that's recommended.

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 56: First Day on 150 mgs of Lamictal

And I felt good (mostly -- read up on the not-quite-good part after the jump).  There was no sign of my mid-afternoon mood trough, but that could be due to the fact that between 4 and 8 pm I was enjoying some pleasant distractions.  From 4 to 6, I was having my hair done by a good friend of mine.  She was the only one in the salon, so we could actually enjoy a personal conversation.  She's just starting out, which means that her schedule has and will continue to be crazy -- so finding time to hang out when she's not doing my hair has been difficult.

My friend is also going through some grandmother drama.  Her grandma had a couple of severe strokes a few weeks ago, and at the age of 90, is not expected to recover.  Fortunately for my friend, her parents were able to find a nursing home and hospice center in their town.  Her parents are able to visit her grandmother daily.  Their town is close enough that my friend can visit weekly.  She greatly values the fact that she can share her grandmother's last few months.

I told her about my own grandmother.  How it's so hard to be so far away.  How it's crazymaking that my aunt and uncle, whatever their intentions, made a decision that went against my grandmother's wishes, and probably against her needs.  They bought a house using grandma's money, and if she needs a nursing home, the money will not be there.  How the difficulty is compounded by the fact that my father and my uncle -- the ones who have financial experience --live so far away from her, and were not consulted when this decision was made.

Lamictal 100 mgs: Some Observations On Mood and Side Effects

My mood has been much better since titrating up to 100 mgs of lamictal.  I'm having fewer mid-afternoon slumps, and when I do have them they're not as severe.  My cognition, motivation, and concentration have continued to improve as well.  Yay!  I might just get my mood to a truly good place before the Equinox heralds the dying of the light.

The side effects of lamictal have continued as well.  Most of them haven't been too problematic, except for loss of appetite, which can lower my mood if I don't make myself eat.  Anyway, here are my observations in greater detail.  I've put the main points in bold for those of you who aren't interested in the greater detail. :)

My sleep has gotten better, though if I keep all the lights on my my living room it can easily be 2 am before I notice.  But I sleep more deeply, and I don't awaken as often during the night.  If I can get to sleep at a reasonable hour, sometimes I can even wake up before my alarm goes off.

My appetite has gotten worse -- much worse.  For most of the day, food just seems unappetizing to me.  I have trouble eating breakfast and have no interest in lunch.  The upside to this is that I've lost the weight I gained on the cursed NorthStar lamotrigine, and I'm beginning to lose some of the weight I gained from Abilify and Lexapro last winter.  The downside is that if I don't force myself to eat breakfast, my mood can suffer.

I'm not sure why, but my body seems to want salt and fat (maybe it wants fat because it craves calories, if not food?) .  The breakfasts that have been appetizing, that I've enjoyed, have been my really weird omelet, a brunch last week that included scrambled eggs and salmon, and a mushroom and spinach empanada I ate yesterday at the farmers' market.  Not sure what's up with that.  I'd love to hear whether other folks taking this med have noticed anything similar.

(Click on "Read More" for observations on skin and muscle tone)

Lamictal Day 54: 100 mgs. Relationship Stress Decreases, yet Appetite Problems Continue,

For the past ten days, I've been hard pressed to differentiate between loss of appetite due to stress and loss of appetite due to medication.  Learning that your mental illness and learning disabilities are fucking up your marriage can do that to you.

Yesterday I experienced a breakthrough with my relationship drama.  My partner expressed some frustrations he's been withholding from me.  I had the opportunity to express some of my own frustrations.  We got to a place where we agreed that our current patters were royally horked, and came up with some creative solutions to address them.  All in all, we both woke up this morning feeling better about our marriage than we have been in days.

I was expecting that the reduction in stress would mean a reduction in my appetite problems.  But no!

Day 48, 100 Mgs: Slept 11 Hours Last Night, but Maybe Appetite Has Returned?

Something happened today that hasn't happened in weeks.  I woke up ... almost ... hungry.


Lack of appetite in the morning has been a problem for me since Week One of lamictal.  It's always been noticeable, but usually I've been able to overcome it.  As I've titrated up, I've gotten worse, until last week it was a four-hour struggle to choke down my breakfast.  At managed to eat just enough to keep exercising, and I lost the couple of pounds that I'd gained on the NorthStar version of lamotrigine.  So that's something to be grateful for.


Last week, a bunch of relationship stress hit the fan, adding to my sleep problems.  I got a couple decent nights' sleep, but by no means enough.  The night before last, I woke up about five times, and I had the following dreams:

1. My husband was angry with me.  Yeah, well ...
2. We were living in our car.
3. We were living in the backseat of our car.  The front seat was occupied by a woman and her baby.
4. We were living in the backseat a car belonging to the narcissistic, verbally abusive mother of a friend of mine.  She was living in the front seat.
5. We were looking at a rental apartment that was in back of a truck stop.  It was fairly nice and spacious, and connected to the truckstop by a corridor with a lovely parquet floor.  It was separated from the truck stop by a pair of flimsy sliding doors.

So, no anxiety about my living situation.  Nope.

Last night was different though.  I felt tired by 11, and went to sleep.  I woke up a few times to pee, but slept really deeply otherwise.  I was actually awake before my alarm went off at 10 am.  I enjoyed 11 hours of fairly good sleep.  I feel well-rested for the first time in recent memory.

Although ... I have to wonder about waking up as often as I do.  Lamictal causes dry mouth, which has me drinking a ton of water.  Am I waking up because I'm drinking all this water, and therefore needing to pee a lot?  Or am I only needing to pee because I wake up and realize that I have to go?  I would so love to get a normal eight or nine hours worth of sleep.

Day 46, 100 mgs: Craving Salt on Lamictal?

One thing I've noticed this past week is the tension between symptoms and side effects.  I'm talking about side effects like reduced appetite and sleep problems -- which are both symptoms of depression, and which both contribute to making depression worse.

I've really struggled with eating for most of the week.  I'm usually hungry by dinner time, but by that point I've had at least eight hours with (usually) insufficient food.  Not good for my mood.  Not good for my ability to exercise, which is not good for my mood.  Not exercising keeps me from sleeping; not eating means that when I do fall asleep, I'm so tired I tend to sleep for much longer than I otherwise would.

When I can choke down some food, I notice that my mood improves immediately.  Of course it does.  One of the things I've learned early on about this illness is that if my mood is unaccountably low, I need to think about when I ate last.  Sometimes, for me, the first indication that I'm hungry is a low mood.

Lamictal 100 mgs: Appetite and Stress

Since I went up to 100 mgs of lamictal my morning appetite has been even worse than it was.  It's just such a chore to choke anything down.  So why bother trying?  Well, not eating will make my mood worse, and that makes the lamictal rather pointless.

Yesterday was harder than most days.  My partner and I had our first session with the marriage counselor to try and deal with our difficulties.  The appointment was at 11, so given the way my appetite has been, I didn't bother to try and eat anything more than a handful of trail mix.  As for the session itself, it was as hard as I expected it to be.  The therapist asked us both to tell the story of how we met, why we were attracted to each other, why we decided to get married.  I can answer each of these questions.  My husband cannot.

WTF?  My partner in life basically has no idea why he wants to be with me, or even why he ever did?

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.

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?

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.