Anyone Tried A Very Low Dose Of Lamictal?

[Nettis]

@joeylittle About the protocols here in Spain - haven't felt there are any :-(

A month ago I found a psychiatrist/gestalt therapist that I like (though I know he's not that experienced - he gets support from a more experienced doctor regarding the meds) and they recommended Lamictal due to my low responses to SSRI and Mirtazapine. He told me that people who haven't been helped from A/Ds often got relief from this drug. He might have seen some Bipolar features in me too (though he recommended Lamictal after only one visit when he didn't really know me at all). I actually feel I can be a little ADHD alike -pushing things, talking fast, changing ideas often etc.

Regarding SNRI nobody have actually mentioned them at all (maybe the first psychiatrist I saw from the Spanish social security system did, don't remember now) and I haven't really thought much about them since I've seen my symptoms as more serotonin deficiency alike (and I assume he feels that way too??). I also heard SNRIs are very difficult to come off.

My symptoms commute between depression (not feeling happy for anything, don't wanting to do things, feeling like a burden, I've even felt suicidal some times during these 11 months I've been bad...) and anxiety. During all the time, I've been scared of going out alone (in the beginning when I took lorazepam (0.5 mg) daily that wasn't a big problem, but now tapering and being on a tiny dose it doesn't work so well). I have been decreasing my need/lust for seeing people=I choose isolation, I have some rumination, some OCD like behavoir, lately I'm also having very early morning wake ups, and the last 3 days I been having a lot of fear, like being in a fright mode. Before this depression I was an incredibly social and very active person, I guess Zoloft helped me in that way too (been more social and have had nearly no anxiety at all after I started taking Zoloft - 20 years ago).

Writing this I can see I'm actually feeling worse now than 2 weeks ago. I'm actually tapering my micro dose of Fluoxetine very slowly reducing 10 % every month - so it might be withdrawal symptoms or it could be the Fluoxetine helped on a slightly higher dose... These last 2 weeks I also tried to add supplements- to help with the withdrawal, first I tried GABA for 4 days (made me very dizzy and really tired), then 5-htp 2 days (made me a little overexcited and stressed) finally I tried Inositol, also for 2 days (which worked better - but made me feel a little stressed too) and decided I didn't want to add more things without having some kind of control. So that's when I said to the doctor I finally wanted to try Lamictal.

Do you think it would be better trying an SNRI before Lactimal? I know you're not a doctor, but what are your thoughts? If you want to share them I'm grateful! or if anyone else have any thoughts...

@TheGirl Thanks for your answer, sounds terrible, poor you :-(

@Panda Bear Thanks!! I do understand it had to work really bad for you if you just lasted a week

 

[Deleted member 34328]

I guess I'm just very naive in all this. I've been taking Lamotrigine/lamictal for over 11 years now for generalized epilepsy. I started it as it is one of the highest recommended medication for safe pregnancies. The dose was raised regularly as the pregnancies progressed.

I honestly had no idea this medication is also used for mood stabilizing/depression/anxiety. I have all 3. I've never had any side effects from Lamotrigine at all.

The SSRI I'm on is below therapeutic levels. I'm generally very sensitive to medications. Celexa nearly had me comatose on 10mg for the first week or so. I've kept the dose at 10mg for 2 years. I've adjusted but only raised the dose to 15mg recently. Same adjustment experience.

I'm taking almost 500mg a day of Lamotrigine with no side effects. My metabolism seems to absorb it easily and I get regular blood tests to monitor it. The pharmacists nearly choke everything I need a refill.

 

[Nettis]

@joeylittle Forgot to answer about abilfy, nobody suggested that one...
@stp2012 Thanks for your comment, it's amazing how differently drugs do affect us. When you started Lamotrigine did you remember if you noticed any improvement in your depression and anxiety?

 

[Deleted member 34328]

@Nettis no I didn't.

I've been on Lamotrigine for 12 years, PTSD has been ongoing for 4. Been taking a tiny dose of celexa for 2 years.

No one...psychologist or neurologist ever suggested raising the dose for depression or anxiety.

My epilepsy started when I was 14. I'm 40 now. It'seems very easily controlled with medication. Other than my medical alert bracelet, I'don't forget I even have it.

 

[joeylittle]

I also heard SNRIs are very difficult to come off.

They are, for most people. However, I will say that they work more quickly - meaning, if you started on something like Cymbalta (which still wins for being the lowest set of side effects), you would notice a slight change in mood and anxiety after 2 weeks. If you didn't notice a change, you could back right off of it, and avoid the worst of the discontinuation symptoms. You can't quite do that with the other major SNRIs.

But, still - if you took it, and decided to stay on it - the odds are high that you would have a difficult time coming off again. It's important that people really grasp this. I'm not trying to make you afraid, just want you to understand that it's been described as unbearably difficult, and some people can't get off of SNRIs for that reason. Personally, I started on cymbalta (duloxetine) and then when it stopped working a few years later, switched to effexor (venlafaxine). I didn't have any discontinuation syndrome side effects at all. They don't hit everyone.

Writing this I can see I'm actually feeling worse now than 2 weeks ago. I'm actually tapering my micro dose of Fluoxetine very slowly reducing 10 % every month - so it might be withdrawal symptoms or it could be the Fluoxetine helped on a slightly higher dose..

After 2 weeks, in my opinion you're experiencing the loss of the fluoxetine in your system, rather than withdrawal/discontinuation effect. Especially if it's mood related. This doesn't mean you should go back up on it, but it does mean it was still doing something, somehow.

One of the problems with all the SSRIs is that they were never meant to be taken long-term. No-one has a good understanding of what they do. So, regardless, I do think it's not a bad idea to be getting off the fluoxetine.

Do you think it would be better trying an SNRI before Lactimal? I know you're not a doctor, but what are your thoughts?

Yep - just want to emphasize that, totally not a doctor.

I think it's a question of how acute your lows are, when they happen - and, whether you want to chance ending up on a medication that you may never be able to come off of, because it's too painful. My experience with Lamictal was that it put everything in a cloud - and while it did help the sharp edges of my depression, it slowed me down too much to function the way I needed to at work. Also, I was having a very light version of one of the physical side effects, which is a tremor - and that was not possible for me to have with some of the work that I do.

Abilify did the same thing as lamictal, except much better - no fogginess, no tremors. I would have stayed on it, except it caused a weight gain that has so far been very hard to reverse. This is true of Abilify (aripriprazole) for many people. I don't know the stats on why it effects who it effects. But for those that it does, it's pretty bad. Which sucks, because it's otherwise a really useful medication.

My personal instinct would be - if you are still on Mirtazapine - to ask your doctor about Abilify as an adjunct medication, basically to replace the fluoxetine. There are decent studies on this combination, and it works well for some people. The only caveat there is, if you are concerned about weight gain, you need to consider it. Though - if you've had weight gain from the remeron, apparently abilify can actually slow that down. (Ugh, medications, why?)

Next, I'd suggest trying the SNRI (and I would recommend cymbalta, though I don't know what's available to you) - for two weeks. I am fairly sure that you will have to come off the mirtazapine first - that's something else to consider.

In the first week, you'll feel like you have a really bad flu. Second week, you should notice an effect on your physical symptoms of depression/anxiety and on your mood. If you are feeling better, and you want to stick with it, then keep on titrating up to the lowest possible dose. But if it seems to not change anything, after 2 weeks, I'd discontinue.

Now, if you don't want to drop the mirtazapine, and abilify isn't an option, Lamictal is a very good option. And the only reason I'm listing it last is that it's higher up there on the negative side effects/dangerous side effects.

That doesn't mean it's dangerous to take Lamictal. Just that it's very powerful.

My epilepsy started when I was 14. I'm 40 now. It'seems very easily controlled with medication. Other than my medical alert bracelet, I'don't forget I even have it.

I've read about this before - for people who have epilepsy, Lamictal can be very effective, and for whatever reason, is irrelevant to mood issues. In other words, you don't get extra bang for your buck, so to speak. It doesn't help with psych issues when the individual needs it as an anti-convulsant.

The science of why was really beyond me. I just remember reading it and finding it interesting. This (I believe) is true for all the anti-convulsants that are also used in psych medicine.

@Nettis - that's just my take on the whole thing. Really, what you'll want to do is get your doctor to sit down with you and ask him about these other approaches, and what he thinks of them. Get him to open up to you a little bit more about his reasoning. Most doctors prescribe what they know best - which is in some ways great, and in others, frustrating. It means they are familiar with the efficacy and side effect profiles of certain drugs more than others. A decent psychiatrist, when asked about a combination that they've not used before, will quickly reach out to colleagues to see if anyone has any experience with it. At a minimum, they will read up on the latest studies.

It's absolutely within your rights to grasp why you're taking certain medications. And it's hard when you're symptomatic, which of course is when switching usually needs to happen. Sigh. Write out notes, so you know what you want to talk about. See in advance whether any medications are going to be cost-prohibitive for you, that can sometimes shorten the list of options. Hang in there.

 

[Panda Bear]

I should add that I tried the Lamictal after I had failed ALL SSRI AND SNRI options.

 

[Nettis]

@ joeylittle Thanks for your extended answer.

Getting off fluoxetine and mirtazapine fast to try Cymbalta is not an option due to my intense withdrawal problems (have to go super slow). It would take me too long.

And about Abilify, as I read and understood it could be as hard or easy to take as Lamictal, it just depends on each person I suppose. So I think I should stick with what the doctor has recommended me and give it a try. I mean the dosage is soooo low =2,5 mg, so I don't think it can do any harm really.

 

[8888]

I'm on 75 mg Lamictal extended release, which I thought was a low dose but apparently not. It helps me. Doc wanted me on 100 mg but that was too much and made me agitated.

 

[Nettis]

Wanted to post an update of my Lamictal journey. I've been taking 1.5 mg of Lamictal for 5 days (1st day, 2 mg). But today I'm getting off them. The first 2 days I felt okay but since then it's been bad. I'm having a very unpleasant pressure inside of my brain (not pain). It feels a little like brain zaps and it has gotten worse every day, I'm feeling unreal/detached off and on, I have felt more depressed, crying and feeling hopeless, dizzy, light-headed, tired, low energy... I just feel this medicine is too strong. Considering I'm only taking 1.5 mg and having so many side effects it doesn't feel safe. Anyone had these side effects starting this med?

 

[joeylittle]

Anyone had these side effects starting this med?

Yes. It's a strong medication, and one starts on a low dose. I've not looked up the dosing recently - but what you are describing is what it does.

You've got to accept that you're going through the introduction to a psych med and keep going for at least 2 weeks. With a drug like this, better to go for a month. Otherwise you won't know anything at all. You will probably acclimate around 7-10 days.

I know it can be unpleasant (to say the least). But if you want to know if this drug is going to help, you absolutely need to keep taking it and get past this point.

A rash is the reason to stop. Otherwise, that all sounds exactly like my own experience.

 

[Panda Bear]

Yes, and worse is what I experienced on the lowest dose possible. But I had a family, 3 small children and one of them with serious special needs. I was rendered completely unable to function by the Lamictal. Couldn't drive safely, cook, clean or care for my family or myself in any way. Curled up on the couch and left my husband to cope with kids and work.

Sometimes we can't give the med a full trial and that's okay. If you can, Joeylittle is right, it takes time to acclimate. But in some cases, it's just not possible.

My psychiatrist weighed the severity to the affects and how many of them I was having. The more I had, the worse they got, the less likely she felt they would fade and the drug would become useful.

 

[Nettis]

@joeylittle
Do you say this is normal? Did you also feel like you couldn't cope with the side effects? I'm feeling very scared because the effects are so strong. I never felt anything like this on any antidepressant...