Lamictal & Abilify: Wacky Side Effects

Images from rxlist.com & drugs.com

Here’s a list of the side effects I’ve experienced recently taking Lamictal and Abilify (I can’t attribute any side effect to a specific drug since I am taking both):

1. Somnolence (I am sleepy within minutes after taking the drugs.)

2. Dizziness/vertigo

3. Tremors (At night, I think I’m having convulsions but my husband says I don’t move.)

4. Delusions (I think I’m dying before I go to sleep.)

5. Disciplined sleep regimen (I wake up for the day when my alarm goes off. That’s consistently been 5:20 in the morning.)

6. Poor balance (This may be related to the dizziness and vertigo.)

 

I’ll add more to this list as I experience any additional side effects.

Lamictal-free and lovin’ it

freeI’ve been off of Lamictal for the past month and a half thanks to a wonderful supportive mental health community of bloggers. I’ve replaced my Lamictal dosage with 1000 mg of Omega-3s derived from fish oil capsules. So far, so good. I haven’t felt suicidal although I do admit I’ve caught myself wanting to feel suicidal. Believe me when I say it’s significant progress to go from feeling suicidal to wanting to feel that way. (By the grace of God.) Special thanks goes to Gianna at Beyond Meds and Stephany at soulful sepulcher.

I haven’t blogged on mental health lately because I haven’t had much to blog about. Any attempt at regular blogging now is mostly done at This Journey Is My Own, which is distinctively personal, reflective, and an unabashedly Christian blog. I guess it can be considered a scrapbook. Thoughts and rambles flowing freely through the blog. I don’t have the attention span, dedication, and motivation to do anything like I used to with depression introspection. I’m not averse to updating this blog every now and then but the months with 80-some odd posts are now gone. The Quotes of the Week should continue updating through early 2010. Enjoy.

Lamictal’s withdrawal effects at 12.5 mg

Half of 25 mg LamictalI’m at half the starting dose now. This means my body still has trace amounts of the drug but it’s so low that it’s not really effective. Here are the side effects I’ve been experiencing:

  • Major brain fog
  • Fatigue
  • Dizzy spells
  • Lethargy (ie, no energy)

I’m also having trouble losing weight but I can’t say for sure if that’s attributable to the medication. If you were on Lamictal or are on Lamictal, what side effects have you experienced?

Ladies & Gentlemen

Landing plane

We are now beginning our descent into Lamictal-free Airport. Please make sure your previous medications are stowed and that your side effects are fully behind you.

At this time, we request that you turn off all dependence on psychiatric devices.

Federal regulations require that you put your seat belt on in the event of any side effects. We hope you enjoyed your flight on GSK Airlines and hope to see your business again on a future medication.

Once again, ladies and gentlemen, we are now at 12.5 mg and are beginning our descent into Lamictal-free Airport.

(Photo source: Wired.com)

Should psych drugs be avoided at ALL costs?

My brain isn’t functioning today quite honestly so my apologies if the following makes no sense whatsoever. It’s long and I ended up rambling.


Lately, I’ve been thinking about whether there are any benefits to using pharmaceutical drugs. I have blogger friends who are very much anti-pharmaceuticals anything, try to avoid drugs as much as possible but take them if necessary, or think pharmaceutical drugs are a Godsend.

I’m still trying to figure out where I stand.

Pharmaceutical companies are in the business of making money. It is not to their advantage to put out completely shoddy products that do not work. I’m sure many of them bury negative data and findings that do not shed a positive light on their drugs but if something works overall, they’ll put it out there. I don’t believe the doctors who are involved in these trials are all dirty, rotten sell-outs. Some of them are very well-meaning and honest who work to make these drugs as effective as possible. Call me naïve if you like but I just can’t bring myself to believe there are more greedy docs who skew results than there are those who are concerned with advancement.

I don’t think twice about popping Excedrin Migraine when I’ve got a painful, debilitating migraine; I have no problem taking naproxen (aka Aleve) when I’ve got menstrual cramps, and taking ibuprofen isn’t an issue if I have severe muscle pain. I don’t question the safety of these drugs. I’ve used them for so long, they’ve proven to be relatively safe for me (not everyone can tolerate those drugs) and efficacious. The safety risk of taking Excedrin Migraine sometimes outweighs the benefits of not taking it. (Note: I only speak of adults in terms of ingesting this kind of medication.I don’t believe developing bodies, such as youngsters, are able to handle medication that can significantly affect mood.)

When it comes to psych meds, I am not anti-medication. Psych meds should be taken on a case-by-case basis. There are some people who consider these meds to be a life-saver while others complain that it has made them miserable and worsened their lives. This is the gamble people take when choosing to ingest a psych med—most people don’t know that. Trouble is, most people don’t know when the stakes are high enough to take that risk.

I shouldn’t be in a position to judge anyone but when I hear people taking antidepressants based on circumstances—a job loss, failed relationship, loss of a life—I worry that it’s unnecessary. We are becoming a nation that is more reliant on “quick fixes” rather than developing coping mechanisms. It’s easier to pop a pill and dull your emotions than it is to face problems, tackle issues head on, and learn to work your way through it. Case in point: rising unemployment hasn’t slowed sales of antidepressants or sleeping pills.

  • I have an aunt who was a violent paranoid-schizophrenic. She was placed in a mental institution and drugged up the wazoo. Now, she’s basically existing; the lights are on but no one’s home. The drugs have killed her. She’s alive but not really.
  • My father was a non-violent paranoid-schizophrenic. It got to the point where we needed to medicate him to get him on track. The medication helped him to function “normally” but his thought processes and physical ability was significantly slowed. He once told me that he felt useless because my mother was busting her butt at work to pay for my college and he was basically an invalid because his mental illness had prevented him from being able to work. He died 4 months later. A few days after the funeral, my mom began to find his psych meds hidden all around the house. I often wonder if the drugs killed him.
  • Another aunt (this is all on the paternal side of the family) also became a paranoid-schizophrenic. She was a brilliant woman who was basically reduced to moving from place to place to the point where she eventually became homeless and could not hold down a job. She disappeared for a while but during one cold winter, was found and brought into a homeless shelter. She was placed on meds and her cognitive functions returned despite the fact that her speech was sometimes garbled. She traveled the world, went on cruises and various excursions. The change was remarkable. Psych meds improved her life and saved her—the benefits of the drugs outweighed the side effects.

As I withdraw from Lamictal, I am curious to see who I am without this drug. Will my creative juices flow freely once again or are they now somewhat hindered? Will my cognitive functioning correct itself or will I forever suffer from problems? Will my short-term memory loss issues smooth out or will I still suffer from intermittent forgetfulness? I have some side effects that may remain with me for a while or perhaps forever (though I hope not) but seeing others fully recover after taking drugs for 10 times longer than I have gives me hope.

I feel the majority of my progress has come from intensive counseling and being infused with the truths as laid out in the Bible. I’d say 90% of my progress has been due to counseling. I give the meds 10%. You can tell I don’t place much stock in them. But they’ve helped to cut down on the mixed episodes.

So far, I haven’t had any suicidal thoughts are behaviors that are out of the ordinary. (Thank GOD.) I’ve been dealing with a mild depression but that stems from basing my worth based off of my career rather than any biological imbalances. The last time I suffered a severe depression, I was on Lexapro (if that tells you anything).

I’ve gotten a lot of resistance and concern from family members who question my decision to come off of the medication. They’ve seen a miraculous change in me and attribute it to being on meds. Meds aren’t a cure-all. They don’t see the counseling and shifting of thought processes going on that has helped me to develop coping mechanisms. Meds may help people “cope” but they don’t develop the tools needed to cope.

I’ve decided that I’ll probably give that Christian psychiatrist a call. My counselor recommended him and she said that he’s very neutral on meds and doesn’t shove them on anyone. I mentioned that I wasn’t sure if anyone would accept me as a patient only to lose me in the end—she insisted he wouldn’t mind. The intake cost is hefty but since I was able to temp a few days for my job this week—I’m not permanently returning, I can swing it.

Which brings me back to my position on psych meds: I said it earlier but I think it’s a case-by-case basis. In my personal life, I’ve seen the benefits outweigh the side effects and I’ve seen the side effects outweigh the benefits. And I’ve seen benefits (not necessarily beneficial) as a result of side effects. Psychiatry is the biggest medical guessing game of all medical specialties. There are no certainties, and there’s no one medication that works best for everyone. Pharmaceutical companies make it a point to put the disclaimer on the patient information sheet that they’re not exactly sure HOW these drugs work. All that stuff about serotonin, dopamine, and neurotransmitters is pure speculation when it comes to depression. You’ll have me convinced about chemical imbalances once I can get a MRI and blood test done. Until then, it’s all trial-and-error.

So if I do suffer from relapses while withdrawing from this medication and it gets to the point where I may need to be hospitalized, I’m not averse to remaining on the drug. Better to be alive and on a psych drug than dead because I was determined not to use it at risk to my safety. If I end up having to stay on the drug, the future of giving birth to children will seem a bit more uncertain.

Generic Lamictal (lamotrigine)

I'm on "Day I-don't-know" of lamotrigine (generic Lamictal). It's been at least 2 weeks. I haven't had any significant side effects except for extreme fatigue. I am often tired. Some days, I can give myself a boost of energy by playing the Wii Fit (which I snagged Saturday afternoon) and other days, exercising just wears me to out to the point where I head to the shower and then to bed. I can have 3 cups of coffee, never become fully awake, and still go to sleep at a decent time.

I'm still not sleeping well. Haven't slept well since before I went into the hospital in October 2006. I can't remember the last time I had truly restful sleep.

My symptoms remain at bay. I haven't had many suicidal thoughts or impulses. In fact, some days, I can go without thinking about suicide at all. I can't say it's all the medicine — my counseling and faith play a much bigger role — but I'm sure the medicine helps.

I've recently noticed that I'm not suffering from as much social anxiety. Again, I don't know if this is due so much to the medication as it is to the resurgence of my spiritual life. I ventured out on Sunday to a meetup writers workshop group that I'd never been to before. It was extremely weird. Not the situation, but the fact that I walked into a room full of strangers, made myself comfortable on the couch at the coffeehouse and offered input quite freely without worrying about what the others thought of me. I even had the audacity to network with a woman who works at a trade magazine in the area. How strange. I don't have balls. This is not me.

What the heck has happened to me?

Lamictal's generic equivalent, lamotrigine, has now hit the market

So much for Miss Up-on-Pharmaceuticals.

I’ve been paying so much attention to Pristiq that the very medication I take slipped out from right under my nose.

How did I find this out? It hit me where it hurt.

In the pockets, of course.

I went to CVS yesterday night for my Lamictal refill. Since I’ve been under my husband’s plan, we’ve been paying about $40 for the medication. So I nearly doubled over when the pharmacy cashier said $54.

WHAT?

I was in a bit of a foul mood about money anyway so the last thing I wanted to do was argue about the cost of my prescription that had jumped up by $14. (Which, in retrospect, I probably should have done because I could have saved $49 right there.)

I came home and made my husband’s day go from bad to worse. He flipped out and got on the phone with his insurance immediately. He said that the max he should pay on any medication is $50 so why was he paying $54 and why the cost rose so sharply.

“Well, sir, it’s because Lamictal has now gone generic and you’re paying the difference between the cost of the medication and the cost of the generic.”

Bob gets off the phone and goes straight to Google News to find out when Lamictal went generic.

Money & drugsAccording to MarketWatch.com, Teva Pharmaceuticals commenced shipment of lamotrigine tablets on July 22nd
. So instead of either the pharmacist asking me if I wanted a generic version or the insurance company letting us know a generic version would be available (it would have saved them money), we ended up paying $49 more than necessary. It appears that Teva’s generic is AB-rated, which means that it has similar strength, bioequivalence, and efficacy. Overall, it likely shouldn’t be a problem if I go from Lamictal to lamotrigine. At least I hope not. We’ll see.

Mood rating:
5

Neurontin 0, Placebo 1. Pfizer loses, Placebo wins.

Stephany at soulful sepulcher has a post up on how Neurontin has not shown itself to be more effective for bipolar disorder than placebo in clinical trials.

It's actually kind of funny that this discovery has been made in April 2008 because I'd reported on this back in January of 2007:

So let's recap: gabapentin is FDA-approved for epilepsy ONLY. But gabapentin has a slew of off-label uses.

Don't know what off-label means? It means "not FDA-approved to be prescribed for this use."

Now that we've got that out of the way, gabapentin is prescribed off-label for migraines, bipolar disorder, social anxiety disorder, OCD, treatment-resistant depression, insomnia, multiple sclerosis, neuropathic pain, and in some instances, post-operative chronic pain.

Where did this off-label usage come from? Basically, one journal article published data on beneficial effects for patients on Neurontin for bipolar disorder and then other articles would cite that article as supporting evidence then more articles cited all the other articles that published the positive efficacy data on the drug, creating what UNC researcher Tim Carey calls the "echo chamber effect."  From Fierce Pharma:

Hearing it over and over, doctors were led to believe that Neurontin worked for bipolar patients, and prescribed it to lots and lots of them.

These articles that touted the benefits of Neurontin were cited 400 times. Carey:

It “becomes a rumor mill in which physicians may be exposed to these types of articles, and citations of articles, which then gives credibility to off-label use.”

The conclusion?

“No scientifically acceptable clinical trial evidence supports use” of the drug in bipolar disorder.

Ouch. Hitting Pfizer where it hurts.

Cognitive functioning

Lately, my cognitive functioning has been absolute CRAP. My thoughts feel slow and dulled. I find myself constantly at a loss for words, especially verbally, which hinders my communication skills. I think this is not only affecting my job performance, but also my social skills on the job. This is probably why I’m making so many mistakes and forgetting things to do despite my endless lists. As a result, I’m worried about applying for a new job and feeling incredibly slow and dull like I do now. I wonder if it is the Lamictal or something else. I didn’t feel this way before I got bumped up to 200 mg, but the problem is quite apparent right now. I’ve become a whiz at solving sudoku puzzles (especially the hard ones!), but now, I’m lucky if I can solve medium. Easy takes me quite a while to finish now. If it is the Lamictal, my husband and I have discussed a trade-off: mixed episodes or the return of cognitive functioning? It’s like choosing between psychotic episodes or obesity. What would your choice be?

I apologize in advance for misspellings or sentences that don’t make sense. In some ways, I miss my pre-200 mg Lamictal self.

Lamictal is hot shit

“In its own way, the best patient group for Lamictal therapy is the bipolar II patient, a person with mild manias and severe depressions.” The side effects are also more tolerable than those of any bipolar drugs: little weight gain, lethargy, or nausea. “It’s the most interesting drug to come along since lithium,” says Ivan Goldberg. “Lamictal is hot shit.”

I found this on soulful sepulcher and have to admit – Lamictal has killed my manias. Since going up to 200 mg in January, I haven’t had a real manic episode – well, it’s really a mixed episode, but whatever. This makes me wonder if the Lamictal IS working; if I’ve tricked myself with a placebo; or if God is just being merciful to me. I try to convince myself with the last two. (Well, I find the latter to be absolutely true.)

Despite my pharma rantings, I have to agree: "Lamictal is hot shit."

Neurontin: Pfizer and Eli Lilly share a common history

My mother-in-law was telling me yesterday about how her hairdresser’s daughter has been diagnosed bipolar with OCD characteristics. She says her daughter’s on “Neo-something” – she couldn’t quite remember the name.

I racked my brain for a bipolar med name that began with “n.” Nothing really came to mind except for neurontin. I told myself, “No, that can’t be right. Isn’t that associated with VNS?”

Nope; Neurontin really is a medication associated with bipolar disorder. Neurontin’s generic name is gabapentin.

Neurontin (gabapentin)

Read the rest of this entry »

Loose Screws Mental Health News

Yeah – the copy editor in me wants to try “Loose Screws News.” For now.

Clinical Psychology and Psychiatry is among many of my favorite blogs to read. In this particular post, he rips on Eli Lilly’s zyprexafacts.com, which was set up in response to NYT articles that alleged Lilly drug reps pushed Zyprexa to physicians for off-label uses. I hope to just have a stupid ol’ time and rip on each Eli Lilly press release in response to each NYT article, but we’ll see what happens. I’ve already got one lined up with notes scribbled on the printout; I just need to transfer it into electronic form. (Oh, the joys of being a transit commuter.)

Liz Spikol linked to an article originally published in bp magazine about how difficult marriages are when one spouse suffers from bipolar disorder. The saddest statistic I’ve ever read:

“In the United States and Canada, at least 40 percent of all marriages fail. But the statistics for marriages involving a person who has bipolar disorder are especially sobering—an estimated 90 percent of these end in divorce, according to a November 2003 article, ‘Managing Bipolar Disorder,’ in Psychology Today.”

Um, joy considering that I’m I suffer from bipolar and have been married for just over a year now. This strikes incredible fear in my heart. It’s not that we don’t love and care for each other, but I can only imagine how much a spouse who doesn’t suffer from bipd can take. I hate to say it, but I keep waiting for my husband to walk out on me. Not because I’m pessimistic (OK, I am, but that’s beside the point), but because I fear that he’ll reach a point where he’ll say, “I can’t take anymore of this! I’ve dealt with this for 10 years and nothing’s changed, nothing’s getting better. I’m sorry, but I can’t be married to you and deal with this anymore.” Just waiting.

Kelly Osborne Retarded celebrity story of the day: Kelly Osborne suffers from depression because she’s so privileged. But hey! — she’ll pose for Playboy and get photoshopped so she can feel better. *gags*

If you’re mentally ill and fired for it, don’t bother suing. It looks like the mentally ill don’t have a case unless there’s a physical illness to somehow “prove” it:

“Sixteen years after Congress enacted the Americans with Disabilities Act (ADA), people with psychiatric disabilities are faring worse in court cases against employers for discrimination than are people with physical disabilities, researchers have found in a national study.

‘People with psychiatric disabilities were less likely to receive a monetary award or job-related benefit, more likely to feel as though they were not treated fairly during the legal proceedings and more likely to believe they received less respect in court,’ said Jeffrey Swanson, Ph.D., a study investigator and an associate professor of psychiatry at Duke University Medical Center.”

I’m not sure how to solve this problem. Psychiatric disabilities are less tangible and harder to prove than a physical disability. It’s easier to wage war against a company if you suffer from a bad back vs. if you suffer from depression. (Whether or not the bad back is a fictional illness is up to you.)

Another oy moment. (The Long Islander in me is coming back full force.) Got a pet that’s misbehaving? Put him or her on an antidepressant. Double oy.

New Zealand is being introduced to lamotrigine (trade name Lamictal in the U.S.). Good luck, bipolar New Zealanders. Best wishes.

And finally, a study has discovered that about half of patients who suffer from some kind of severe burn suffer from clinical depression. (Shouldn’t someone diagnose this as PTSD? That’s pretty traumatic, if you ask me.) While the finding isn’t surprising, the study highlights the need not only to treat the physical ailment, but also to address the mental healing necessary to overcome stress from the injury.

Drugging of the Bipolar Mind

From Philip Dawdy's article, "The Drugging of the American Mind," originally published in the Seattle Weekly:

"Classically, the disorder is treated with a mood stabilizer. Lithium was long the gold standard. In recent years, there has been a shift to anticonvulsants like Depakote or Lamictal. Often, bipolars are also given an antidepressant like Paxil or Effexor to deal with bouts of depression. Until 2000, the mood stabilizer plus antidepressant approach was essentially the state-of-the-art treatment. It just doesn't knock down symptoms forever.

Bipolars can "break through" these meds and wind up having acute episodes of rage or suicidal depression."

Wow. The article was published just over a year ago and it describes me to a T today. Well done, Mr. Dawdy, for seeing my future.

"This is an awkward time for mental- health experts, researchers, and advocates. This month, a peer-reviewed academic paper was published on the Public Library of Science Web site pointing out that researchers still have not proved the serotonin-imbalance-in-the-brain hypothesis of depression. What proof there is, the authors claim, is mostly circumstantial. Two weeks ago, The Wall Street Journal ran an article covering the same points in relation to antidepressants."

That was in November 2005. It's good to know that I'm not the only one that sees the neurotransmitter link to mental illness as merely a hypothesis and NOT fact. Many people don't know that at the bottom of each psych med Web site and in the important safety information sheet that comes with a psych med basically says, "We're not exactly sure how this works." Well, gee, thanks for allowing me to take a risk about something you're not even sure about!

Praise to Dawdy, amazing blogger for Furious Seaons,  for uncovering much of this information that most people in America don't want to cover or are too lazy to educate themselves about.

SSRIs

Selective Serotonin Reuptake Inhibitors
(from monstersandcritics.com)

  • present fewer side effects than their predecessors
  • less likely to be lethal even in large quantities (important for someone who may be suicidal)
  • the
    Federal Drug Administration (FDA) wants SSRI dosage minimized to
    decrease risk of overdosage and close monitoring of younger patients on
    the drug
  • suicide rates overall have declined since SSRI market introduction
  • side effects ma include insomnia, rashes, headaches, joint and muscle pain, upset stomach, nausea or diarrhea
  • mixed with painkillers, SSRIs can pave the way for stomach or uterine bleeding

In the Hindustan Times,
an article ran on a girl who committed suicide because she had not
received the grades she had hoped on a test. One highlight (if you can
consider it that) of reading world news is that they'll report local
suicides more often than U.S. media. The HT story reminds me that there
is no excuse too small or too big for people to commit suicide.

Indian focus recently has been on eliminating suicide scenes from films to prevent copycat cases. In one incident,
a mother dragged her four kids out o the train tracks to die with her.
Two of them were able to escape and survive before a train pummeled the
rest of the family to death.

Ireland is also tackling suicide – they've set a 20 percent reduction target by the year 2016. A published report notes that suicide rates are rising in males younger than 35 and in females under 25. Wisconsin
is battling youth suicide, much like Ireland, and hopes to reduce its
current rate of one young adult committing suicide per week by 10
percent. No time frame for the reduction has been set.

An anti-seizure drug, Neurontin, is being blamed for nearly 300 suicides nationwide.
It is the best-selling anticonvulsant medicine in the U.S. and Pfizer –
Neurontin's maker – posted profits of more than $2.6 billion in 2004.
The FDA has not pushed to have Neurontin taken off the market, but in
2005, simply ordered a review. The results have never been made public
as of today.

A man who killed himself after being turned away from the hospital has drawn worldwide attention to the inadequacies of Australia's mental health system. Although I'm sure similar events have occured in the U.S., it likely does not get widespread coverage.