Lamictal 200 mgs: Bruxism is Back?

In a previous post, I wrote about how lamictal has affected my muscle tone.  I'm no longer stiff after working out, and my muscles in general are looser.  In the same post I wrote that my bruxism had improved a lot on lamictal -- I no longer seemed to grind my teeth at night, and my jaw wasn't clenched when I woke up in the morning.  This was pretty great, since I've ground my teeth my whole life.

In recent days, it seems like the bruxism is returning.  My jaw isn't clenched when I wake up, but the muscles there are a bit sore.  I'm not sure whether this is a side effect wearing off or not.  I certainly hope not.

So I'm currently testing a theory: that the jaw pain is actually related to stiffness in my neck.  I've been noticing for a few weeks now that my neck has been stiff in a way that once landed me in physical therapy, where I got a lecture about proper sitting posture while working at a computer (or playing a keyboard instrument, which was the real issue at the time).

Ironically, I think this problem arose because I was trying to be more ergonomically correct.  Generally, I'd been working on the couch with my laptop.  A few weeks ago, when I started using my sun lamp in the mornings, it was easier to set it up on my studio table than to prop it up next to me on the couch.  And anyway, using an ergonomically designed external keyboard should be better for me, right?

I now think I was wrong.

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).

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)

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.

Day 37: NorthStar Lamotrigine Side Effects

I spent all last week bitching about it, but in case you missed all that, my lamictal titration was interrupted by a change in generic brands, from Teva to NorthStar.  Back when I first started lamictal, my pdoc told me that generic lamotrigine  can vary significantly in bioavailability.  Teva lamotrigine, he explained, is the only generic that's remotely equivalent to brand-name lamotrigine.  The pills made by other manufacturers can have up to 20% less of the medication in them.

I spent all last week on NorthStar lamotrigine.  Allegedly, I was taking 75 mgs a day.  My psychiatrist wonders if my body was getting any of the med at all.  It was doing bugger-all for my mood, but there still seemed to be side effects.  Here's what I noticed:

Lamictal Day 32: Thoughts on NorthStar Lamotrigine

This is Day 4 on NorthStar lamotrigine, and so far I'm not impressed.

As I've mentioned previously, I switched pharmacies to fill my latest lamictal scrip, and my current pharmacy (Costco) sells a generic made by NorthStar.  This means that there is less available medication in the pill, possibly as little as 80% of what Teva's lamotrigine has (Teva's bioavailability is equivalent to Lamictal the brand name med).

In theory, I should still be getting more medication than I was last week.  Last week I was taking 50 mgs of Teva lamotrigine.  This week I'm taking at least 60 mgs of NorthStar lamotrigine.

If that's the case, why do I feel like crap in real life?

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 15: Up to 50 mgs, and Reflections on the First Two Weeks.

Today I titrated up to 50 mgs of lamictal.

I've been at 25 mgs for two weeks.  Before starting lamictal, I was definitely experiencing mild mood swings, mostly between anxiety and the kind of sadness that tells me I'm not in The Black Pit of Depression yet, but I could find myself circling it if I'm not careful.  The lasting cognitive effects and "flattening" I'd experienced on Lexapro had finally abated.

Since starting lamictal, my mood has stabilized and improved somewhat, and so far there doesn't seem to be any negative effects on my attention, motivation, or focus (thank the gods!).  The only cognitive effect was some word-finding issues, and drawing a visual blank regarding a recipe I'd made many times before, but I only experienced this on one particular day.

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.

Muscle stiffness, teeth grinding and lamictal/lamotrigine

A lot of people have reported muscle stiffness when taking Lamictal/lamotrigine.  Jared Poole of the inestimable CrazyMeds describes them this way:

... everything from just a twinge in your neck or back to full-body aches that make you wonder if you were possessed by some spirit that made you participate in a triathalon the day before and have no memory of it.

This had me concerned.  As I've mentioned before, I'm a weight lifter, and DOMS (delayed-onset muscle stiffness) was already a problem for me.

Wonder of wonders; lamotrigine (so far) seems to be improving my general muscle stiffness!  Yay!  DOMS is nowhere near as bad as it used to be.  Using the foam roller after working out doesn't have be swearing like a sailor because of the pain.  

But the real miracle is that my bruxism seems to be significantly diminished, maybe even gone entirely.  I've ground my teeth for as long as I can remember.  Getting my wisdom teeth removed helped somewhat, but my dentist still prescribed a mouth guard to wear at night.  Being on SSRI's and stimulants didn't help this at all, of course, but I've ground my teeth even when I've been taking no drugs for my brain.  

I can't tell you how nice it is to wake up without my jaw clenched.