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

Walgreens: It's Where to Get Decent (Teva) Lamotrigine

As I mentioned here, since I wrote about my experiences with the horrible NorthStar version of lamotrigine (generic lamictal), I've noticed that the top google phrases that lead to my blog are things like "NorthStar lamotrigine" and "NorthStar lamotrigine side effects".

Lamictal is a very unusual drug in that its generic versions can vary widely, not just in the side effects produced, or even in efficacy, but the actual bioavailability of the drug itself.  Officially, some generics only have 80% of the bioavailable medication that brand name Lamictal does.  In fact, the only generic that is identical to brand name Lamictal is produced by the drug company Teva.

Most health plans ding you for buying a brand name drug when a generic is available.  In fact, many will refuse to pay for a brand name drug at all, unless your doctor specifies it on your prescription.  Obviously, then, the thing to do is get your hands on Teva lamotrigine.  But not all pharmacies carry it.  So where do you find it?

Lamictal Day 39: 125 mgs? Oops.

I'm supposed to be taking 75 mgs of lamictal.  Today I accidentally took 125.  For a drug which can have serious consequences if too much is taken too soon, this could have been a serious mistake.  So far though, the only side effect seems to be some mild tachycardia, which went away after I meditated.

How did I manage to screw this up?  Well, in order to replace the disastrous NorthStar lamotrigine, a prescription which my psychiatrist had written for 25 mg pills, I needed a different denomination of pills in order for my scrip to be covered by insurance.  Lamictal and lamotrigine apparently don't come in a 50 mg denomination (no, that would be easy).  My pdoc had to write the scrip for 100 mgs, and then I was supposed to break them in half, and cut the remaining piece in half, and thus achieve 75 mgs.  Kind of confusing.  To help explain, here's a picture of Teva lamotrigine:

As you can see, they're scored down the middle, so it's pretty easy to break them in half and get 50 mgs. To break one of those halves in half takes a sharp knife, but it's doable.  I know this because I did it yesterday.  Then I put the half of a half tablet back into the medicine bottle.

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?

Day 30, 75 mgs: Generic Lamotrigine Is Not Created Equal

When my pdoc first prescribed lamotrigine to me, he warned me that it was not all created equal.  The pills manufactured by Teva, he explained, have the same bioavailability as Lamictal, the brand name version.  The effective dose in a pill made by other manufacturers can vary dramatically.  If my generic got changed up on me, he said, I need to let him know.

This weekend, I titrated up to 75 mgs of lamotrigine.  I felt calmer, after having experienced some agitation toward the end of last week.  My mood was a bit lower.  Is this the "mood stabilizing" effect of lamictal? I wondered.  A few weeks ago I was feeling cheerful.  Is the higher dose bringing me down?

Yesterday I had my first late-afternoon mood dip in a few weeks; I felt vulnerable and slightly unbalanced, as if I was standing on the middle of a seesaw.  If the lamictal were really stabilizing me, I should be ... well, stable.  No mood swings.

Then it hit me -- I'd gotten my scrip filled at Costco, which uses generic lamotrigine made by NorthStar.  Walgreens, where I'd gotten my first scrip filled, used Teva.  Teva's got the highest effective dose of any of the generics.  Who the hell knows what dose NorthStar has?

John McManamy and the People's DSM: Finally, some reality.

I've been reading John McManamy's site recently.  He's the author of Living Well with Depression and Bipolar Disorder, a highly regarded book that I haven't read yet.  He's a journalist, he lives with bipolar, and he's got a pretty good grasp of brain science.

He's also got a fascinating project going called The People's DSM.  The forthcoming revision of the DSM 5 has a ton of problems.  It contradicts itself, it ignores the role that stress plays in triggering mental illness, and it generally continues the fine DSM tradition of lacking real scientific basis.

The People's DSM is an effort to create a way of categorizing and diagnosing mental illness based on the actual realities of -- get this -- people who have actual mental illnesses.

Definitely the Lamictal Stupids, and they're different than ADHD

Over at the CrazyMeds anti-convulsant page, Jared Poole talks about "the stupids" as a common side effect of anti-epileptic drugs.  Yesterday I wrote about having trouble finding the words for some of the art materials I've used for years.  Last night I had another such experience.

I was making dinner.  It's a dish I've been making for years and it's very simple.  First you throw some garlic in the food processor and grind it up finely.  Then you ... um ...

It wasn't just that I couldn't find the words.  When words are "on the tip of my tongue" my visual cortex often kicks in and supplies me with an image of the object, which I recognize and can then name.  This was as if there was a hole where these ideas should be.

My First Day On lamictal/lamotrigine: 12.5 mgs

When my psychiatrist prescribed lamictal, he went down a list of Important Things to Know.  The most important is how to deal with the dreaded Lamictal Rash (which can be fatal, which is bad):

1. If a skin rash occurs with a fever, go to the emergency room immediately (and)
2. Call me

He warned me about the need to titrate slowly, as he was directing me, to avoid the dreaded Lamictal Rash.  And, he said, if the generic manufacturer was switched, I needed to call him.  Not all generics are equal.  Some have more bioavailability.  Lamotrigine manufactured by Teva, he says, can be equivalent to the next highest dosage.

I was supposed to start at 25 mgs, but when I looked at the bottle, there it was -- made by Teva.  I decided to break the pill in half (it's scored, which means that this is OK) and start at 12.5 mgs and leave a message for my doctor letting him know that.  I really need this medication to work out for me, so I don't want to run any risk of The Rash, and it seems best to play it safe.

I took the med about 5 hours ago. At the time I took it, my cognition had returned to normal, and my mood, though fluctuating, was more or less positive.

Mood	Elevated, calm
Cognition	Focus, motivation, concentration normal
Hypomania	none
Sleepiness	tolerable
Dizziness	none
Headache	none
Nausea	none
Abdominal Pain	none
Back Pain	none
Dry Skin	none
Acne	none
Tremor	none
Blurred Vision	none
Lack of Coordination	none
Muscle Pain	none
Dry Mouth	Noticeable