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.

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?

Are You Here Because You Searched on "Northstar Lamotrigine"?

I was taking a look at the stats for this blog, and it seems that the most popular search terms have to do with NorthStar lamotrigine and its side effects.  This makes me wonder -- who else out there had a horrible experience with NorthStar lamictal/lamotrigine?

Google tells me that at least a few people besides me have had it run them off the rails.  If you've also had this experience, and if you feel comfortable sharing your story in the comments, please do so.  I think it would help a lot of people.

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:

Day 36: Back on Teva Lamotrigine, Thank the Gods

As I related yesterday, my pdoc called in a new lamotrigine scrip, this time at my local Walgreens, which carries the pills manufactured by Teva.  The NorthStar crap I'd been on just wasn't cutting it.  I'm taking 50 mgs for a few days, and then I get to try to cut half of a 100 mg pill in half to get 75 ... my psychiatrist seemed to think this is possible, so I hope he's right.

I'm already feeling better, though my inner monologue points out that it's bright and sunny for the first time in a week.  Confound those confounding factors!  I spent my weekly visit to the local Farmers' Market ruminating on the number of things that can impact my mood disorder.  Things like sunlight, which is beyond my control.  Or the micronutrients in my diet, which are sort of within my control, except that I can't afford to buy a lot of organic produce these days.

I told myself that my rumination was probably not helping me.  Yeah? said my ruminating voice.  Who else is going to take care of these things?  I'm the only one who knows how I'm feeling, who can track that with what I'm eating or how much music I listen to or any of these other factors.  It's not like there's anybody else living in my head!


I realized that this was something to be grateful for.  And thus I was enlightened.

Day 35 on Lamictal: Changing Back to Teva Tomorrow

I got in touch with my pdoc and told him I wanted to go back onto the Teva lamotrigine as soon as was physically possible.  He's calling in the scrip right now.  By tomorrow I hope to be approaching normal again.

Yesterday wound up going hellishly bad.  By early afternoon I felt like I wanted to die.  My mood picked up a bit after that, but I still felt low and sad about some pretty ridiculous things, like the imagined suffering of the beans I was cooking for dinner.  Until 8 pm or so, when, like clockwork, my mood picked up.

My psychiatrist said, and I quote, "God knows what's going on", but that there's a good chance that 75 mgs of the NorthStar med is effectively less medication than 50 mgs of the Teva (at least in my particular instance).  It's even possible, he said, that I'm not accessing any of the medication at all for whatever reason.  He wants me to stay at 50 mgs of Teva lamotrigine for a few days, just in case, before going up to 75 mgs.

Today has been better than yesterday, though still not good.  I've felt low, sad, and simultaneously anxious and dull.  On the other hand, knowing that I'm getting off this NorthStar crap gives me something to look forward to.  I can't wait for tomorrow.

Lamictal Day 34: Mood Instability and Depression Due to Variance in Lamotrigine Generics?

Last Friday, day 28, was my first bad day since I started lamictal.  Saturday was my first day at 75 mgs, but I filled my scrip at a different pharmacy, and that meant a different generic manufacturer.  I'd been taking lamotrigine made by Teva for the first four weeks, and now I'm taking NorthStar.  Since then, I feel like I've had many more bad days than good. 

This really feels like a different, less effective medication.  My mood, cognition, and motivation are all suffering.  There have been some days where I've bee unable to get important things done, like cooking dinner or getting scrips filled.  Looking back over the last several days, I'm clearly much less stable than I had been (and I'm not remembering this accurately, which makes me glad I'm keeping this damn blog).  I'm back to my 4 pm crash.

Today, I feel better than I have most days since starting at 75 mgs, but I still feel way lower than I did last week, or any day of the previous 4 weeks.  This sucks incredibly.  I'm trying to just sit with it, let it be what it is, and not get caught up in depressive thoughts.