Lamictal, Abilify, And Direct Sunlight -- They're Not Kidding

The little sheet they gave me with my Abilify scrip warns against direct sunlight.  Lamictal, as we know, can really screw with your skin.  Combine those with an outdoor baseball game and you have ... well ... screwed up skin.

I attended a baseball game three weeks ago.  In spite of the 60 SPF sunblock I put on my arms, they're still peeling.  After three weeks.  As for my shins, where I forgot to apply sunblock entirely, let's just say that they were pretty screwed up.

At first they followed the usual sunburn pattern.  They turned red and sensitive.  They started peeling.  Then, surprise!  Petechiea.  Those are those little red spots on the skin which I experienced on Day 2 after exercising.  They went away after a few days, and I am once again peeling like a mofo.

I burn pretty easily, but I've never had a burn like this that just keeps peeling.  Needless to say I broke out the aloe.  But I would have been happier if I'd applied more sunblock.

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.

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.

Side Effect #5: Increased Skin Sensitivity

Lamictal and Skin Sensitivity


Welcome to Post #5 in my series of the most troublesome or persistent side effects of lamictal.  I've written 10 posts about skin reactions.  Nothing serious happened to me -- I've avoided Steven's-Johnson Syndrome, a.k.a. the Deadly Rash -- but my skin has been more sensitive, especially when I first started titrating up.

That being said, I'm spending a bit more time on this post; we've all been warned about the Dread Rash of Doom, and because of that a lot of people stop taking this med unnecessarily the first minute *anything* strange happens to their skin.  Most of the time it's not SJS.  However, I am not a doctor, so don't go construing this as medical advice, people!

The skin effects I noticed were as follows:

1. Something like heat rash on my second day of lamictal (at 25 mgs).  This continued for the first two weeks I was on the med, and was particularly noticeable after exercising.
2. "Combination skin", or simultaneous dry skin and acne.  
3. Sensitivity to heat (like when I open the oven door).
4. Tactile sensitivity in general; for instance, it would hurt noticeably more when my cat scrapes her tongue across my face.  
5. Returning rash when titrating up to 50 mgs.
6. Sunburn happens faster than usual and is more severe.  Since I'm pretty damn white, "usual" happens pretty quickly anyway.
7. Sensitivity to chemicals, such as Advantage flea control.
8. Niacin rash, which turns out to be a sunburn-like reaction to niacin, also known as vitamin B3.  It's in a lot of grains.  It happened to me after drinking too much electrolyte replacement drink and eating multi-grain waffles. This has never happened to me before (and I know I've OD'd on gatorade before this), but since cutting down on the electrolyte beverage, it hasn't happened since.

There you have it.  Several skin reactions to lamictal that ARE NOT Steven's-Johnson.  For the rest of my series, check out #1: Delayed Sleep Phase; #2: Loss of Appetite; #3: Digestive Issues, and #4: Weird Food Cravings.

Niacin Rash vs Lamictal Rash: Why You Should Be Careful with Supplements

Disclaimer: this is not medical advice.  I am not a doctor.  If you take lamictal, and experience an unexplained rash, contact your doctor immediately.

Before I left for my trip, I had kind of a weird experience.

I was sitting at my studio table, typing away in front of my sun lamp, when I suddenly felt sunburned.  It came on very suddenly, almost in an instant.  Since lamictal can cause a deadly rash, I tend to freak out every time something weird happens to my skin.  The rash, officially called Stevens-Johnson, is so serious that a lot of pdocs will take you off lamictal if you have any kind of rash at all.  Now, it's pretty uncommon to experience the rash after the first two weeks on the med, and even rarer after the first eight weeks, but nonetheless I started to feel panicked.  I'd just been offered a job -- what if I have to go off my meds, at this time of year?  I wouldn't be able to work.  I wouldn't be able to do anything.

The rash was on my cheeks, nose, around my lips, on my chin, and even on my elbows ... but not on the rest of my arms.  It looked something like this: (I wanted to play with my drawing tablet, so I drew this.  Note the quivering lips and sad, shocked expression.)

(I wanted to play with my drawing tablet, so I drew this.  Note the quivering lips and sad, shocked expression.)

As always, I googled the question, and determined that the lamictal rash does not present as a feeling of sunburn.  I actually knew this but had forgotten it in my panic.  Then I googled "rashes that feel like sunburn."  I turned up a bunch of hits for something called a "niacin rash".  Niacin, or vitamin B3, is found in grains, and if you take too much of it, it can cause a sunburn-like rash, and if you keep taking too much of it, something called pellagra.

I had been eating one of my whole grain waffles as the rash appeared.  But I eat those every day, and I've never gotten a rash before.   So where was all of this niacin coming from?

I thought about it, and realized that the electrolyte mix I'd been taking to try and ease my lamictal constipation was also a vitamin supplement.  Maybe that contained niacin.  For the last few days, I'd been drinking 4 to 6 packets a day, just like the directions said ...

I double checked the box, and learned that, yes, it does contain niacin.  But I'm not supposed to take 4 to 6 packets a day.  I'm supposed to mix 1 or 2 packets into 4 to 6 oz. of water.  ADD strikes again.

Lesson learned.

Lamictal 150 mgs: Fun with Flea Control

Lamictal is a med known for its ability to cause skin problems.  People complain of dry skin, acne, dermatitis, rashes, and then of course there's The Potentially Fatal Rash.

I've had dermatitis off and on since starting lamictal.  It was worse when I first started, and has gradually decreased as I've titrated up.  Nonethleless, my skin is still more sensitive than it used to be. The elastic on a pair of underwear may never have bothered me before, but now it's itchy and irritating.  The itchy irritation of bug bites are exacerbated.  I got a few spider bites several weeks ago, and ordinarily they'd have healed by now -- but they're still red and angry looking.  At least they've finally stopped itching!

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 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.

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.

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?

The rash is back, but it's still not THE rash

In my second post, I wrote about a benign rash I noticed while I was enjoying my post-workout soak.  Checked it with my pdoc, all was well.  Yesterday I noticed it again -- also post-workout.  I'm guessing that it's related to heat and sweat generated during my lifting session.

I couldn't get a good picture of it, but the photo it most resembles can be found here.  The difference, I guess, is that it wasn't on my eyelids, and did not result from near-asphyxiation.

It's looking like intermittent sweat rash may just be something I get to live with on this med.

Lamictal Day 3: 25 mgs

So far, so good.  My mood is definitely better today than it has been in pretty much forever.  Technically it's too soon for me to be feeling any effects from the lamotrigine, but whatever.  We're all different, right?  And I've proven myself to be pretty sensitive to medications in the past.

Yesterday I had a nervous moment when I got out of the shower and saw that my skin was covered in tiny red pin-prick looking things.  They weren't bumpy, they didn't itch or hurt, and I wasn't running a fever.  They also looked nothing like the rashes I saw when I googled "lamictal rash".  I dropped my doctor an email just to be safe, and he wrote back to say that what I was describing was benign, but to keep him posted of ANY skin changes.

Lamictal Day 2: 25 mgs

My doctor tells me that Teva is actually the only generic that has the same bioavailability as name brand Lamictal, so I took 25 mgs today.  So far, so good.

Yesterday my mood slumped during the late afternoon/early evening, which is typical, but the slump seemed worse than usual.  After I ate dinner I felt fine, so perhaps it was just low blood sugar.

I also had a bit of a scare last night when my chest and belly started itching.  I scratched the itch, and it turned red, and I thought, is this the dreaded rash?  On the other hand, sometimes I just get dermatitis, and the itchiness was within the realm of normal for me.  I figured I'd give it until this morning before worrying about it.  Lo and behold, the rash was gone an hour after I stopped scratching it.

My mouth is pretty dry, and it tastes like something died in it sometimes, but that's what water and gum are for, right?