Lamictal withdrawal + sickness = out of it

I'm most likely out of commission for the week. I traveled this past weekend and came down with this nasty cold. Along with tapering down on Lamictal, I'm feeling kind of spacey and out of it. Thanks to a good friend's advice, I'm holding off on tapering down some more until I'm feeling better. So right now, I can't tell whether I'm suffering from Lamictal withdrawal, the effects of a common cold, or a combination of the two.

Except for the blurry vision — I've had that since starting Lamictal and the withdrawal is making the difference much more, er, visible.

Coming off of Lamictal (lamotrigine): 200 mg to 150 mg

I'm currently experiencing significant blurry vision and fatigue. I feel like my eyes keep crossing and I have to blink several times and keep my eyes wide open to focus well. It's annoying. My mood is stable at a 6. I also think I have a slightly weakened immune system as I'm starting to get sick.

Coming off of Lamictal (lamotrigine)

I am officially joining the ranks of those who are facing the challenge of Lamictal withdrawal.

On Wednesday, I went to see my psychiatrist with a plan to come off of Lamictal:

• 150 mg for 3 months
• 100 mg for 3 months
• 75 mg for 3 months
• 50 mg for 3 months
• 25 mg for 3 months
• 12.5 mg (depending on whether my side effects on the 25 mg are bad)

I told him that my husband and I were looking to have a child sometime next year and that I’d like to taper off of Lamictal but was open to the possibility of getting back on it should I encounter severe suicidal ideation and mixed episodes. He warned me against it and thought it was a bad idea.

He proceeded to say that it’s a maintenance medication, I have a lifelong disorder, it won’t just go away, my symptoms would probably return, I have a higher risk of attempting suicide, blah blah blah — am I aware of all these risks?

He explained people with bipolar depression after coming off of meds can actually be worse, undergo severe depressive episodes, have more suicide attempts, and yadda yadda yadda. To sum it all up, I was risking my life just to get off of Lamictal.

My pdoc was trying to scare me into staying medicated.

He then added if I really wanted to come off of my meds, I could “just stop.”

WHAT?! My eyes flew open.

He stated he’d had patients who had stopped cold turkey without a problem. According to him, anticonvulsants don’t have severe withdrawal effects.

WHAT?! His advice just flies in the face of what most doctors recommend. In fact, quitting Lamictal immediately increases the risk of seizures, which is exactly what I’m afraid of.

Philip’s experience and Gianna’s experience along with the comments on each blog are proof that many people have experienced tremendous withdrawal effects from decreasing Lamictal’s dosage. In the past, I’ve quit Paxil and Lexapro cold turkey — both with not-so-good results to put it mildly.

I insisted that I wanted to come off of it slowly so he said I could just cut my 200 mg pills in half and jump down to 100 mg and stop after 2 weeks.

For real? Two weeks, doc? I had a plan that would take me over a year and you’re reducing it to a mere two weeks? On 100 mg dosage?

Again, I insisted that I wanted to take more time. He reluctantly wrote me a 30-day prescription for 100 mg and said since I was off the medication, I had no need to see him anymore. “Good luck,” he flatly told me.

When I came home after the appointment (and a bitching session to my husband), I remembered that I’d stashed a few 150 mg pills away sometime ago after I jumped back up to 200. So as of Wednesday, my arsenal included:

• A bottle of six 150 mg pills
• A bottle twenty-five 200 mg pills
• A prescription for thirty 100 mg pills

I dropped down to the 150 mg on Wednesday and have been doing all right so far. I intend to keep myself at 150 mg (cutting the 200 mg and the 100 mg in half) for at least 2 weeks, then drop down to 75 mg for 2 weeks and then 50 mg for 2 weeks. I’m most worried about coming off of the 25 mg. This is a way more accelerated plan that I hoped for but I’ve got to work with the cards that I’m dealt.

We’ll see what happens.

Lamictal in consideration of pregnancy

My husband and I are talking about expanding our family. While that sounds all well and good, I just have one issue:

Lamictal.

For most women, they think, “Well, I want a kid” and the most they have to do is probably get off birth control. Just finish off their contraceptives, maybe feel a little nauseous, and move forward with their plans.

(sigh) Not me. If I want to do this right, it might be a good 6 months or so before I can consider trying.

December

I have since learned that December is also a hard month for me. December has certain markers, so to speak, that jump out at me throughout the month.

December 9 — The day my father died
December 14 — The day I found out
December 17 — The funeral
December 18 — The burial

Makes for quite a depressing Christmas. Even though he passed away only 7 years ago, it still hangs a dark cloud over my head. It takes me so long to get into the “Christmas spirit.” I now settle into the Christmas mood a week before the holiday, which is somewhat frustrating because it took me almost a month to finally enjoy hearing Nat King Cole’s smooth voice crooning through the ceiling speakers at Barnes and Noble.

I think celebrating Advent next year might help, however, I never know much about the season anymore since I no longer attend Catholic church and the Presbyterian church I attend doesn’t seem to acknowledge it. I need to remember that Christ is “the reason for the season” (yes, I know it’s trite) but the materialism surrounding Christmas really does a good job of distracting me from focusing on that. Materialism is tangible; Christ is not. But materials are temporal; Christ is eternal. Something to keep in mind.

I’ve been incredibly busy lately and have gotten pretty sidetracked from blogging. I’m traveling a good bit this (and the coming) year, trying to get a personal website up and running, running errands and accomplishing chores, trying to fit in exercise, spend time with friends and family, attend (usually) church-related activities, and make time for myself at night. My life in the past 2 years has moved faster than I could even imagine or fathom. The introduction of children could only make it crazier.

How’s my mental health in spite of all this? Well, I was doing pretty well most of the year with the exception of my “normal” dive in August. Lately, I’ve been dealing with some suicidal thoughts again. Mostly passing and no serious urges but the idea of trying has been tempting. I mentioned recently that I’ve felt a “need to prove” that I am serious about committing suicide. It’s a serious pride issue. Why should I care whether people think I’m suicidal for attention or not? That doesn’t matter. I shouldn’t be more concerned about what people think of me. Rather, I should be more focused on living my life to please God and for His glory.

I’m currently reading a book by J.I. Packer titled “God’s Plans for You.” (You can read a preview of this book through Google Books.) Lately, I’ve been struggling with what I should do with my life. I’m experiencing what has been deemed a “quarter-life crisis.” It’s like a mid-life crisis but with different challenges. Usually those challenges are related to career and vocational decisions. The mid- to late-twenties is the time when college grads are hit with the reality that full-time work isn’t as idealistic as they hoped and they are faced with the grim realization that some—or many—of their dreams may never come true.

This is becoming the case with me.

I obtained a degree in print journalism and a minor in English, hoping that I could enjoy working as a reporter or copy editor in the newspaper or magazine industry. It started out that way but then a move to Pennsylvania and a switch to daytime hours and a lack of clips set me back and now I am a freelance proofreader. Granted, I’m fortunate to even be a freelancer at 26 but proofreading at an ad agency was NOT what I had in mind when I took on my student loan debt.

While I enjoy the people I work with and have become more comfortable with the materials that come across my desk, I again have fallen into the perfectionism trap. I had a week where I caught a string of my own mistakes that I’d missed (other people—non-proofreaders—had caught them) and it was extremely discouraging. This has led me to wonder whether I’m even in the appropriate field. Now, I have a desire to pick up writing again (as opposed to sole editing) and am frustrated at my lack of internal motivation. I’m even beginning to wonder whether I should go back to a full-time job because it’s tough not knowing when a check will drop in my lap during any given day of a month and the fact that I am a terrible boss and employee when it comes to meeting my own deadlines. I’m even afraid of getting audited come tax time.

All in all, I’m currently facing a slew of decisions. Where to take my career and the prospect of motherhood, which may be hindered by my Lamictal (lamotrigine) treatment. I don’t want to be taking Lamictal during a pregnancy unless absolutely necessary and right now, I don’t feel that it’s absolutely necessary. I would like to take the risk and come off of it to see what happens but so far, it sounds like Lamictal withdrawal can be hellish. Lamictal during pregnancy raises the risk of a baby being born with a cleft palate. The likelihood of that happening to me is low and even if it does happen, it’s fixable but why take the chance? I’m also the super-psycho freak that will halt topical steroid medication of my eczema and zealously check all toys “Made in China” for lead.

Gianna at Beyond Meds and CLPsych over at Clinical Psychology and Psychiatry have written pieces on how Lamictal’s efficacy has been shown to be no better than placebo. This is something I intend on writing about soon considering that I’m one of the patients who could probably (currently, anyway) sing the wonders of the drug.

So there’s the update. That’s what’s going on in my life. I hope that you are all well. I likely won’t post again before 2009 so I’d like to wish you all a Happy New Year!

Mood rating: 5

Requisite Update

There’s nothing much going on. My brain is mush and no matter how much sleep I get, I’m constantly tired. My husband is convinced that my fatigue stems from the generic Lamictal. The next time I see my psychiatrist, I’m likely going to go back to the brand Lamictal. It’s an additional $45 but if it helps this fatigue, then it’s worth it. I feel like such a zombie. Hence, why I haven’t really been blogging.

I’ve also been feeling lazy. I’m currently at this "I don’t care" stage where there’s a lot of things that I’m not obsessive about anymore so in a sense, that’s good.

So here is your requisite update. I’m still alive, still tired, but doing fine. (No suicidal thoughts, depression at bay.)

I’ll enjoy it while it lasts. Let me know how you are. I’ll make my blog rounds eventually.

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.

According 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

"What's wrong with you?"

"You’re the most promising person that’s walked through my doors in a long time."

So says the new psychiatrist I went to see today. It was a pretty funny visit but worthless. I’m not sure that this post will communicate that effectively.

Suicide Attempt: 1,346,985 (number is an exaggeration)

I had a serious mixed-mood episode during the weekend. I remember wanting to buy brownie mix at 1 am and refusing to answer my
husband’s question, "What’s your mood rating at?" because I knew I’d
answer 10. But then my husband woke up in the middle of the night to find his cell phone charger cord wrapped around my neck as I tried to strangle myself. I vaguely remember it.

Abilify is starting to sound better. Abilify or brain fog on Lamictal? I can’t decide. Sometimes, I do wonder if he’d be better off without me. I often think I’d be better off without myself.

Current Mood Rating: 4.9