Lamictal, 250 mgs: So Far, So Good

Two weeks ago, I dropped from 300 mg to 250 mg. In the past few days, I've noticed that I'm feeling a bit sharper, mentally. I've begun craving healthy food again, after several years of craving salt, fat, and sweets (normally, I'm one of those lucky people who can normally look at a plate of cookies dispassionately; not so on Lamictal). Best of all, there's been no drop in my mood whatsoever!

The downside: I've had some GI issues (constipation and gas). My muscles are stiffer. I've also been really tired, but this might be my body's way of telling me it's OK to lower my Ativan dosage as well :)

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.

Lamictal 300 mgs: Side Effect #3 -- Digestion Issues

The third post in my series of the most bothersome side effects of lamictal concerns the third largest tag in my list of side effects: GI issues.  GI issues with brain meds are pretty common.  Ever med I've ever been on has warned of nausea, for instance, but I never had this problem.  And for the first couple months of titration, and then only after titrating up to a higher dose, but it always went away after a few days.

Then I went up to 150 mgs.

In general, I'm not prone to digestive problems.  I've thrown up only twice since I was ten or twelve years old.  I can eat just about anything without getting heartburn, stomachache, or nausea.  But at 150 mgs, I found myself gassy, bloated, and constipated -- to the point where I bought a huge bag of prunes.  Not that they helped much.

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 300 mgs: Side Effects Lessening

A few days ago I went up to what I hope will be my final dose of lamictal -- 300 mgs.

I've been experiencing some not fun side effects since titrating up to 150 six weeks ago.  In addition to some pretty obnoxious GI complaints, my mouth felt like the Sahara desert most of the time, so I was drinking gallons of water, and having to pee every 15 minutes.

Last week, that seemed to improve.  I was taking a three hour car trip from my grandmother's current abode to her new house.  She hates to stop on road trips if she can avoid it, so I sucked on xylitol mints and tried not to give in to my thirst.  It worked.  The cool thing was that it continued to work after that.  My mouth felt less dry, I needed less water, I wasn't running to the bathroom constantly.  I only had to use the bathroom once during my six hour flight from the East to the West coast.

Lamictal, Constipation, and Electrolytes

I promise, I'll stop writing about constipation soon.  Because I think it's finally going away. 

In a post last week, I wondered whether my GI problems might be caused by a minor electrolyte imbalance.  Electrolyte imbalance isn't a common cause of constipation.  Usually the culprit is a low-fiber diet.  My diet includes enough fruits and veggies that this shouldn't be a problem.  I tried eating prunes, and Cheerios, and and anything else that might have a laxative effect, but no luck.

I thought that perhaps the lamictal dry mouth is causing me to drink so much water that I'm pissing away electrolytes.  Over the weekend, I started drinking Emergen-C, which in addition to crazy amounts of vitamin C (which I don't really care about) serves as an electrolyte replacement drink.

And I can report that it helped enormously.  Can't say that I'm back to normal, but I'm feeling so much better.  So if you're having GI issues with lamictal, try drinking gatorade or any other electrolyte replacement beverage.  It might really help.

Lamictal 200 mgs: Electrolyte Imbalance Causing Constipation?

I've been bitching for several weeks about the sudden constipation that accompanied my titration up to 150 mgs of lamictal, and that seems only to have gotten worse when I went up to 200 mgs.  This side effect has been particularly distressing because I basically can't do anything about it.  When you're constipated, it's usually because you're not getting enough fiber, right?  So add fiber to your diet and you'll be fine.

Problem is, I was already eating a high-fiber diet, with plenty of greens, fruit, and whole grains.  I tried adding prunes, water soluble fiber, and laxative tea (the last one doesn't help much, since you aren't supposed to take laxatives for more than a week at a time).  Then I tried adding Cheerios, which I really can't stand, but decided to try because they've always been my personal Laxative of Last Resort.

Each of these interventions has helped ... sometimes.  And only slightly.

Lamictal 200 mgs: Cheerios, the Laxative of Last Resort

After experiencing some relief from bloating and gas (but not the constipation) that emerged when I titrated up to 150 mgs, I landed right back there when I hit 200.  My stomach hurts, my pants don't fit, and -- I'm sorry if I'm being gross here -- I just want to take a godsdamn shit.


This has brought me to my Laxative of Last Resort: Cheerios.

Since I was a teenager, Cheerios have gone right through me.  This is one reason I hate them.  The other reason is that they were the only cereal deemed to be "healthy enough" by my parents, so I ate them every effing morning until I was eight years old.  My friends, of course, got to eat Fruit Loops or Frosted Flakes or Lucky Charms.

My parents told me that my suffering was due to the fact that they loved me enough to make sure that my teeth didn't rot and I developed healthy eating habits.  Like most young children, I didn't believe them.  They made me eat Cheerios because they were mean!

Then, O glorious day!  Special K made the cut!  It was so exciting compared to those effing Cheerios!  I swore I would never eat Cheerios again.  And for the most part, I stuck by this promise to myself.  The exception was if I went to Girl Scout camp.  Cheerios got put in our gorp for some reason.  I noticed that not only did they made me run for the latrine, but they gave me mild heartburn.  I started eating around them.

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: Investing in Prunes, Gas-X, and Ginger Tea

I used to enjoy the stomach of a concrete elephant.  I never get the stomach flu.  Hell, I never even throw up.  Haven't since I was 12.  OK, there are two exceptions to this; the first was after three strong drinks, several clove cigarettes (I don't normally smoke), and a stack of strawberry pancakes.  The second was a few years ago when my husband's two-year-old cousin had the plague and every singe person who even touched her was knocked down flat.

I am now 36.  I have barfed exactly twice in 24 years.

As for other digestive complaints, I don't have 'em.  I'm not prone to indigestion, acid reflux, diarrhea, or constipation.  When I start a new med, I pretty much ignore the GI tract side effects because I know they won't bother me.  As I said, concrete elephant.

Until I went up to 150 mgs of lamictal, that is.

Lamictal 150 mgs: Possibly Too Much Information

For the past two weeks, since titrating up to 150 mgs of lamictal, I've been having some ... issues ... with certain side effects.  If you're squeamish, you may want to browse the rest of this blog.  If you want to hear about my GI and urinary tract issues, please click through.

Lamictal Day 55, 150 Mgs: Some GI Advice

Let's just say ... when you're on this medication, and you gotta go, YOU GOTTA GO.  Now.

That is all.

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 20, 50 mgs: GI issues, sleep, and ... feeling cheerful?

Yesterday I was having some GI issues -- gassy, bloated, and constipated.  Also some heartburn.  I've been a bit constipated since going up to 50 mgs, but I don't know if the other issues were med related or not.  I didn't eat anything out of the ordinary.

My mood is definitely improving.  The pattern seems to be that I start the morning slightly low in terms of energy and mood (by which I mean I feel more "meh" than "neutral".  Put THAT in your DSM and smoke it).  Throughout the day, my mood rises, until by late afternoon or evening I sometimes feel downright cheerful.  For a cynical bastard such as myself, this is a bit alarming.

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?