Jmizz: Lamictal taper suggestions

[Jmizz]

Hi guys, I’m new but I have been reading a lot and this seems to be really good info. Especially the stuff I read from Altostrata. 

 

My story:

 

i took escitalopram for 4.5 month, the last month being an accelerated taper bc lexapro never worked in the least for me and looking back now I believe it gave me akathisia when I increased to 20mg. Anyway, about 3 weeks after I hit 0mg, after the physical stuff subsided, I got hammered with emotional turmoil and I’m pretty sure the akathisia came back 5 fold. I couldn’t sit still, horrible anxiety followed by depressive fits that seemed to cycle and sadness/hopelessness. It almost  seemed like I was bipolar and thus I ended up on lamictal a month ago. I can sit still now but Im still emotionally wrecked. Mainly I just can’t quit hyperfocusing on how bad I want to feel normal and be off this stuff. I started questioning everything and researching on my own. I now believe it was just lexapro withdrawal I was dealing with and now I’m on lamictal at 50mg. I did 25 mg for 2 weeks and have since been on 50mg for around 31 days total. What do you guys recommend for me in terms of a taper. I don’t want to compound the ssri withdrawal with another medicine.

 

note: I also take 50mg of trazodone to sleep bc it’s been the only way I could get any sleep for this entire process.

 

Thanks in advance,

J

Edited November 14, 2019 by Shep
removed real name (Sassenach), added username to title (Shep)

[Jmizz]

I posted already but maybe in the wrong forum. I’m new and still figuring this out.

 

My story:

 

I fought lexapro generic for over 4.5 months. The last 1.5 months spent weaning down 20-10-0. I realize this was way too fast but knowing what I know now, I’m fairly certain 3 weeks after I got to 20mg it induced akathisia. I was told it was anxiety and to give the medicine time. However not being able to sit still or sit down and watch tv, and pacing around all day or being outside on a swing to get relief, didn’t seem right or like any anxiety I’ve had before. At 3 months in I was done. So I withdrew 20-10 for 3.5 weeks and 10-5 for 3 weeks. Then I stopped. I felt good for a week, man I was so happy. I was dealing with physical withdraw but mentally I felt better than I had in months. Then around 18 days in after the physical stuff subsided, i was introduced to post acute withdrawal. A month off I couldn’t take it, gave buspar a 12 day disaster trial, then was told maybe an SNRI. Cymbalta 5 day disaster. I was told agitated depression and maybe something on the bipolar spectrum, hence the lamictal im now on. My gut was telling me it was the medicine, and the withdrawal, I’ve never had any type of bipolar like episodes ever. But I was also told to stop scouring the internet bc it was worsening my anxiety. I kind of wish I wouldn’t have now. It definitely seemed like akathisia on the medicines and then once my post acute withdrawal started from what I know now. Anyway, what do you guys think? 

 

I think i want to get off the lamictal but now I’m 32 days into taking it and can assume even at only 50 mg it’s going to be hard getting off. Any suggestions for my situation would be appreciated. 

 

 

Sidenote: I take 50mg of trazodone also bc I’ve had insomnia since the first pill. 

[Sassenach]

Hello        and welcome to SA.

 

This site is run entirely by volunteer Administrators and Moderators, all have been through or going through withdrawal.

There are no commercial interests or influences  involved .

 

I am sorry you are having such a rough time but you are now in the right place.

 

The site is currently extremely busy so please ensure you answer any requests from staff fully.

I have edited your signature as we ask members not to use there real name.

We need a timeline for your drugs and any supplements you may be taking so could you

Please add a signature.  Include drugs, doses, dates, and discontinuations & reinstatements in the last 12-24 months. Also include supplements. This will help us give you the most accurate advice we can. 

• Any drugs and supplements prior to 24 months ago can just be listed with start and stop years. 
• Please use actual dates or approximate dates (mid-June, Late October) rather than relative time frames (last week, 3 months ago) 
• Spell out months, e.g. "October" or "Oct."; 9/1/2016 can be interpreted as Jan. 9, 2016 or Sept. 1, 2016. 
• Please leave out symptoms and diagnoses. 
• A list is easier to understand than one or multiple paragraphs. 
• This is a direct link to your signature:/settings/signature/

On 11/12/2019 at 3:26 PM, Jmizz said:

I now believe it was just lexapro withdrawal I was dealing with

You are correct.

Please see the links below to help explain what is happening.

the-windows-and-waves-pattern-of-stabilization/

why-taper-by-10-of-my-dosage/

the-rule-of-3kis-keep-it-simple-keep-it-slow-keep-it-stable/

derealization-or-depersonalization-dr-and-dp/

On 11/12/2019 at 3:26 PM, Jmizz said:

What do you guys recommend for me in terms of a taper. I don’t want to compound the ssri withdrawal with another medicine.

Until we have the timeline we cannot make a recommendation.

Your system needs consistency to help achieve stability.

As soon as we recieve the drugs info. we can assess your situation.

In the meantime DO NOT MAKE ANY CHANGE TO YOUR CURRENT MEDS please.

Please feel free to browse the site, it is a wealth of info.

Other members threads will give you an insight and the opportunity to share experiences.

 

Again welcome.

 

Sassenach

 

 

 

[Jmizz]

Ok thanks for reply:

 

- sertraline 50mg early May-2016 thru November 2016 (no issues)

 

-sertraline 50mg (April 1 2019- April 13 2019)

-lexapro 10-20mg (April 27 2019 - August 19 2019)

-trazodone 50mg early (April 2019 - current )

-Buspirone 7.5 3x a day (September 19 2019 - September 30 2019)

-cymbalta 20mg (early October (5 days)

-Lamictal  (early October 2019- present at 50 mg after 2 weeks 25)

-ativan 0.5 once a day rarely 

 

[Jmizz]

Ok thanks for reply:

 

- sertraline 50mg early May-2016 thru November 2016 (no issues)

 

-sertraline 50mg (April 1 2019- April 13 2019)

-lexapro 10-20mg (April 27 2019 - August 19 2019)

-trazodone 50mg early (April 2019 - current )

-Buspirone 7.5 3x a day (September 19 2019 - September 30 2019)

-cymbalta 20mg (early October (5 days)

-Lamictal  (early October 2019- present at 50 mg after 2 weeks 25)

-ativan 0.5 once a day rarely 

 

I might add I had like 1 good week at 10mg lex and 1 good week after going to 20, otherwise I haven’t been stable at all. The lamictal seemed to help some but since I got to 50mg I became scared to go up as the higher dose seemed to worsen things. 

[Jmizz]

I feel like I should add here that I’m a bad shape. Like I have no control or stability to be able to manage a taper, I’m already in the thick of it. Going back to lexapro makes no sense bc its prob been too long and I had a paradoxical reaction almost from the start, which may have been due to being updosed way too fast bc “my anxiety wasn’t controlled.” Reading some of what alto has said, I now realize adding lamictal was a terrible mistake, but they had me convinced I had some bipolar spectrum disorder. The inner restless and wanting to be moving around seemed to get worse again once I got to 50mg lamictal, but also may be just an increase in my already increased anxiety bc I’m coming to terms finally that im in a huge mess. My doctor suggests taking the ativan daily as I’m pretty sure she thinks this will pass shortly and also expects im going to keep increasing to 100. But I know that’s a terrible idea. I’m miserable. It’s frustrating. 

[Sassenach]

Hi Jmizz

 

@Altostrata

 

I have added your drug history to your signature so it now appears below every entry you make.

Please check and confirm it is correct, if not please amend.

What is your doctor prescribing Ativan for?

16 hours ago, Jmizz said:

Like I have no control or stability to be able to manage a taper

You need to achieve stability before considering a taper.

I am going to refer this to a senior mod because you are taking two A/Ds and a benzo.

Are you taking any supplements, if so please add details to your drug signature.

Please list your current symptoms

dr-joseph-glenmullens-withdrawal-symptom-checklist/

When do you take each of drugs?

Do you feel better or worse after doses?

The senior mods will need the above info to analyse your condition.

 

Sassenach

 

Edited November 14, 2019 by Sassenach
misspelling

[manymoretodays]

Hi Jmizz and welcome,

I got your signature done.  You can further edit it if you would like, by using the link that Sassenach gave you above.  Can you see it below your posts now?  I went ahead and bolded some parts of it as well.

 

That you are on the trazodone is important.  It's possible and really probable,  that you have been having adverse effects from most of your drugs tried since you have been on the trazodone.  That itself, is going to take awhile to recover from.

Take a look here: Tips for tapering off trazodone

In the very first and most informative post, about trazodone, you'll see..........starting with this bolded section:  Traffic jams with antidepressants in the liver  And I couldn't help but see all the drugs you've tried since the trazodone, including Lexapro and then, up through the Cymbalta, are listed as having Major interactions with the trazodone. 

 

Oh my gosh!!!  You might talk to your prescriber about this, if you can.  It sounds like you are really struggling right now.

And oh best Jmizz. 

Love, peace, healing, and growth,

mmt

 

Oh okay, I see that Sassenach has posted as well.

Edited November 14, 2019 by manymoretodays
removed white space

[Jmizz]

Edit: I’m on one a/d (traz) and anti convulsant lamictal currently, with ativan as needed. 

 

I had a horrible reaction to sertraline right off the bat which is what led to the trazodone bc I couldn’t sleep at all. 

 

Trazodone very well could have caused problems with the lexapro the whole time, but I did have a couple good weeks, once at 10mg and once at 20mg. Then it would get bad again. I was also drinking on them without knowing at the time and have stopped that completely. 

 

I took ativan for about 12 days in a row during the startup on lexapro and then prob 9 days in a row after moving to 20mg bc I was told increased anxiety is normal. Knowing what I know now I may have been dependent on ativan the whole time after that. What a mess. There was definitely a terrible reaction 3 weeks post lexapro cessation which led to more ativan. I always tried not to take it multiple days in a row.

 

my current situation is this:

 

-i take 50mg of lamictal at 8am

   - aside from the first two days of each new dose, I don’t seem to feel much, maybe just a little jittery at times a few hours after 

 

-i take 50mg of trazodone at 9pm makes me sleep like a baby and is the only time I feel relaxed 

 

-0.5 ativan as sparingly as I can

 

 

heres the scary thing, since going to 50 mg of lamictal I’ve used the ativan more than I’d like to get through work and events the past couple weeks.

 

now if I take it, I feel almost completely myself, until it wears off. That’s prob not a good sign 

 

in regards to trazodone, ativan has no effect on me sleep wise, if I remove trazodone first. I’ll never be able to sleep

 

please help

 

 

[Jmizz]

19 hours ago, Sassenach said:

Hi Jmizz

 

@Altostrata

 

I have added your drug history to your signature so it now appears below every entry you make.

Please check and confirm it is correct, if not please amend.

What is your doctor prescribing Ativan for?

You need to achieve stability before considering a taper.

I am going to refer this to a senior mod because you are taking two A/Ds and a benzo.

Are you taking any supplements, if so please add details to your drug signature.

Please list your current symptoms

dr-joseph-glenmullens-withdrawal-symptom-checklist/

When do you take each of drugs?

Do you feel better or worse after doses?

The senior mods will need the above info to analyse your condition.

 

Sassenach

 

 

[Jmizz]

@Sassenach

I’m sorry, I’m still trying to learn how to quote and respond etc. The ativan is bc my brain absolutely will not shut off. Her answer was to titrate up  There are times when I feel no physical anxiety but my brain is on fire. It’s always worse on medicine. The meds prob just aggravate the akathisia from the initial lexapro withdrawal?? But here I am now on 50mg Lamictal and feeling like I need to take ativan more and more to function. I just don’t even know where to start.

[Altostrata]

Welcome, Jm.

 

On 11/13/2019 at 8:00 PM, Jmizz said:

The inner restless and wanting to be moving around seemed to get worse again once I got to 50mg lamictal

 

What times of day do you take Lamictal? Are your symptoms worse at any particular times of day?

 

In the last 2 weeks, how often have you taken Ativan? Are you taking any other drugs?

 

Lamictal may not be as terrible a mistake as you think. Please do your best to stay calm.

 

Very few doctors know anything about tapering psychiatric drugs or withdrawal syndrome. Any psychiatric diagnosis bestowed while one is experiencing adverse drug effects is simply invalid, including "bipolar whatever."

[Jmizz]

@Altostrata

 

-i take 50mg lamictal at 8am

-I take 50mg of trazodone at 9pm

- I used the 0.5mg ativan very sparingly throughout this process sometimes 0.25

 

however, I’m a fireman, shiftwork 24 hour shifts and I’ve tried to go back to work and act like none of this is really happening. Sometimes not getting good sleep there doesn’t help as well as being stressed. For the past two weeks I’ve taken the 2nd 4th 6th 9th 11th and then 14th and 15th as ive been having some bad thoughts the last few days after finding this website and realizing my problems may be far more than I originally thought . I was doing as ok as I could be before I came across this site and all the stories. Hopefully I’ll be able to change my attitude about that soon.

 

symptoms:

 

-early wake usually between 5-6, restless legs after trazodone wears off, can’t go back to sleep, mind races

- usually my mornings are low mood and anxiety would be tolerable unless provoked by something 

-afternoons usually starting around 3-4pm is when I would struggle with anxiety that seemed brought on by nothing

 

i do find the lamictal has helped some with my afternoon anxiety, especially the physical symptoms, and maybe brought my mood up a tad, as I don’t fall into pits...but the mind racing and hopelessness is still strong. I was told to go up to 75 then 100 but I find it has maybe aggravated my akathisia symptoms since going to 50. It’s hard to decipher between anxiety but it’s tormenting and I pace a lot, incapable of sitting and watching television or relaxing...but it’s been that way ever since About 3 weeks on lexapro.

 

is it possible I’m kindling on the ativan? And can I suffer through a few days and rectify that? The problem is ativan is the only thing that seems to quiet my mind, however the last few days even that is having a hard time keeping me calm.

 

ive found through this process I’m hypersensitive to every little feeling in my body and the medication seems to exacerbate that besides the ativan. The lamictal doesn’t make me as jittery as lexapro did, but I was also still using caffeine before I knew better.

 

thank you guys for trying to help me

 

should my first priority be trying to stop taking the benzo before I get to a point where it will be too hard?

[manymoretodays]

Hey Jmizz,

I was just working on trying to help you clarify for Alto.  You might be able to get a good plan going with Alto's help.  Best to try for conciseness.  And without a whole lot of speculation just yet.

6 minutes ago, Jmizz said:

I was doing as ok as I could be before I came across this site and all the stories. Hopefully I’ll be able to change my attitude about that soon.

Yes.  That happens to many.  Try, just for now, to stick with your own stuff.  And some of the general topics.  There are times when it seems/feels like mass hysteria here, even to me, a seasoned vet.

 

I think that the only thing you might have missed, in answering Alto's questions was: 

2 hours ago, Altostrata said:

In the last 2 weeks, how often have you taken Ativan?

 

And yah, if I were you I sure wouldn't want to be going up anymore on the Lamictal.  As that's twice now that you've thought that it could be making things worse.

Okay....all from me.  Glad you could pop on back in today.

 

L, P, H, and G,

mmt

[Jmizz]

@Altostrata

 

-i take 50mg lamictal at 8am

-I take 50mg of trazodone at 9pm

- I used the 0.5mg ativan very sparingly throughout this process sometimes 0.25

-I guess in the last 2 weeks for ativan prob 7 times, maybe one day I took 0.5 morning and then 0.25 evening 

 

however, I’m a fireman, shiftwork 24 hour shifts and I’ve tried to go back to work and act like none of this is really happening. Sometimes not getting good sleep there doesn’t help as well as being stressed. For the past two weeks I’ve taken the 2nd 4th 6th 9th 11th and then 14th and 15th as ive been having some bad thoughts the last few days after finding this website and realizing my problems may be far more than I originally thought . I was doing as ok as I could be before I came across this site and all the stories. Hopefully I’ll be able to change my attitude about that soon.

 

symptoms:

 

-early wake usually between 5-6, restless legs after trazodone wears off, can’t go back to sleep, mind races

- usually my mornings are low mood and anxiety would be tolerable unless provoked by something 

-afternoons usually starting around 3-4pm is when I would struggle with anxiety that seemed brought on by nothing

 

i do find the lamictal has helped some with my afternoon anxiety, especially the physical symptoms, and maybe brought my mood up a tad, as I don’t fall into pits...but the mind racing and hopelessness is still strong. I was told to go up to 75 then 100 but I find it has maybe aggravated my akathisia symptoms since going to 50. It’s hard to decipher between anxiety but it’s tormenting and I pace a lot, incapable of sitting and watching television or relaxing...but it’s been that way ever since About 3 weeks on lexapro.

 

is it possible I’m kindling on the ativan? And can I suffer through a few days and rectify that? The problem is ativan is the only thing that seems to quiet my mind, however the last few days even that is having a hard time keeping me calm.

 

ive found through this process I’m hypersensitive to every little feeling in my body and the medication seems to exacerbate that besides the ativan. The lamictal doesn’t make me as jittery as lexapro did, but I was also still using caffeine before I knew better.

 

thank you guys for trying to help me

 

should my first priority be trying to stop taking the benzo before I get to a point where it will be too hard?

[Jmizz]

Thanks @manymoretodays I edited to say how many times I took it more clearly. 

 

A lot of my problem is also anxiety about taking medicine, which is probably odd considering the predicament I’m in. I do feel there has been some benefits from lamictal. I was functioning pretty good until I stumbled upon akathisia and somehow that led me to this site. It’s been a rough few days sense. My pacing symptoms are worse when I feel stress or get myself worked up. That’s why they have been especially bad the past few days. Mostly the times I sit still is when I’m online looking at stuff I probably shouldn’t, but that seems to be my out sometimes instead of pacing, and that’s been going on for a while. Even prior to lamictal.  Sorry for rambling, just trying to explain as much as I can. 

[Altostrata]

You may be getting rebound anxiety from the Ativan when it wears off, even if occasional.

 

1 hour ago, Jmizz said:

I was told to go up to 75 then 100 but I find it has maybe aggravated my akathisia symptoms since going to 50.

 

Lamictal can be activating at too-high dosage.

 

Lamotrigine has a short half-life and is often dosed twice a day. What I would do is divide the dose: 25mg at your usual time in the morning and 25mg 12 hours later in the evening. Make the transition like this: Take the morning 25mg as usual, take the second 25mg an hour later. Keep moving the second dose an hour a day later until you are taking it at night.

 

This may relieve whatever activating effects you feel from it and distribute the benefits over a full 24 hours. It's possible this will enable you to avoid taking Ativan and reduce trazodone, which may also be adding to daytime anxiety with its evil metabolite mCPP.

 

For background, see

 

Tips for tapering off Lamictal (lamotrigine)

 

Tips for tapering off trazodone (Desyrel)

 

On 11/14/2019 at 12:25 PM, Jmizz said:

I had a horrible reaction to sertraline right off the bat which is what led to the trazodone bc I couldn’t sleep at all. 

 

This is a very bad error by your prescriber. Sertraline was either dosed too high or not compatible with your body.

 

We can all understand why you are afraid of your drugs. You might find that lamotrigine is helpful in stabilizing your nervous system. Please continue to let us know how you're doing.

[Jmizz]

Ok so I should hold tight on the 50mg and work on getting to where I take it twice a day 12 hours apart. I’ll try to avoid the ativan. And then eventually begin to lower trazodone. Wow I didn’t realize how bad trazodone was, ive thought of it as my saving grace this whole time. If I follow the taper should my sleep still be ok, and if I can’t sleep is that a sign to hold or updose? I guess I’ll look at the link before I ask all these questions. 

 

Do you think the bad thoughts I’ve had the past few days are more related to the negative mindset I had once I found this website, or interdose withdrawal from ativan? The fact that they started almost immediately upon the change in attitude I had about my situation makes me hope it’s more related to that feeling of hopelessness which I’ll work on changing that outlook. It is what it is.

[Altostrata]

Dividing the 50mg lamotrigine dose probably will reduce the adverse reaction you get a few hours later; when the full load hits your nervous system,  you get a paradoxical reaction (activation instead of calming).

 

You may not be getting adverse effects from trazodone.

 

It's understandable that you have become fearful and apprehensive. However, I think you'll pull through, but this is going to be slow and take months. Just stay as calm as possible and "change the channel" when you start to worry.

 

By the way, yours is an absolutely classic case of what's wrong with psychiatric drug prescribing, including misdiagnosis of adverse reactions and withdrawal syndrome, and inappropriate psychiatric diagnosis. Your doctor might be a nice person and good in other areas but you should not take advice about psychiatric drugs from her, ever.

[Jmizz]

I made the mistake of going to a GP and NP first. They screwed me up bad. This new psychiatrist is who put me on lamictal. She means well but I think she believes she’s treating an anxiety disorder with a mood component right now that didn’t respond to antidepressants. She doesn’t believe I’m bipolar, even though I had myself convinced. However she did put my on cymbalta and 5 days after, I went back and told her no shot. And she also wants me to take 100mg of lamictal, so she does mean well but I don’t know how much faith I have in any doctors at the moment .

 

the end game is eventually to be off all of this stuff, correct? So when you say months, you’re saying months until I get stabilized enough to begin to taper?

 

 

 

[Altostrata]

Any doctor can prescribe these drugs, it doesn't have to be a psychiatrist. Can you communicate better with your GP? Getting your prescription in 25mg dosage will be more convenient for you. Doctor has to write prescription as "split dosage."

 

If you want to give this psychiatrist one last chance, you might explain the alternate theory of the case and request the prescription for 25mg tablets from her. She seems very ordinary in her blind spots, which is to say -- she doesn't know a bean about adverse drug reactions.

 

Idea is to get your nervous system to settle down and then sneak off the drugs.

[Jmizz]

I’m going to see her Monday. I will explain that I want to stay at 50 bc it seems slightly activating even at 50mg. Then I will suggest the doses being separated morning and evening. At this point I’m just going to use her to supply me with what I need to follow your instructions.

 

Did you guys have appetite issues. I’ll be glad when I’m excited to eat food again.

[Jmizz]

Hey guys, so I stayed off the ativan today and made sure to pay close attention. I’ve been in good spirits as I feel a little better after talking to you guys. So I took 25mg at 8am and 25 at 9am. At around 1pm I started feeling the activation. It makes sense from what I’ve read about peak concentration 4.5 hours or so after taking. This is very similar to how the lexapro felt, however far less activating. I think working towards 25 am 25pm seems like a good idea. Wishing I never would have updosed to 50. It’s been about 3.5 weeks. Too far out to try and get back down to 25? I feel mostly stable minus the jitters I get, which I often mistake as anxiety or can cause me anxiety on top. I will update how I feel the rest of the afternoon. 

[Altostrata]

Too much lamotrigine at once can affect appetite.

 

Given your experience with akathisia, 25mg lamotrigine twice a day may help your system settle down and enable you to reduce trazodone. Then, you could taper off lamotrigine.

 

Not sure what a reduction to 25mg would do right now. It's a big change. Once you get a schedule set for the two 25mg doses, you could start tapering each one.

 

Lamotrigine is not a bad drug, compared to the others. It's an anti-seizure drug that calms the nervous system. At the right dosage, you probably won't feel it. Men can take higher doses than women.

[Jmizz]

i didn’t provide this info in my intro for some reason. My whole situation started with anxiety/stress induced ibs that led to more anxiety, rumination, issues with panic and agoraphobia and then eventually a depressed mood. The fact that I took sertraline in 2016 with no issue has been confusing to me this whole time. But now I believe the newly developed issues I was having with panic led to the horrible reaction I had this time around. Tendency for panic was another red flag for starting off on a high dose that I wish wasn’t missed by doctors, but they prob assumed since i had no issues last time, it would work fine this time.  Lamictal is helping me be more social and get out of the house more slowly but surely. I don’t feel the panicky anxiety as bad as when my withdrawal started. Only really now when I feel overly stressed. Even taking it all at once it’s not near as horrible as lexapro. If I can get to a point where I don’t really feel the medicine, I’ll be doing relative good. So hopefully splitting the doses will help and also help my appetite come back some. Then my only concern would be that I don’t know if I can sleep without help, as the first dose of ssri exacerbated my panic and activated me so bad I haven’t felt like I could fall asleep without help since. But that’s gonna be a slow process getting off my help anyway .

 

as for the akathisia, it’s so hard for me to know. It seems dependent on my anxiety/stress level. So that may not be real akathisia and possibly just restlessness from anxiety when it peaks? Especially since I calmed down yesterday and seem more at ease today and am actually watching some football and playing with my kid. I seem more at peace doing things like being outside and driving. So it’s probably just anxiety related to when I’m inactive and ruminate too much. Or maybe the medicine is helping, just have bad moments. Who knows. Anyway, I should try to focus elsewhere for a while and give my mind a break. I’ll quit bugging you guys and update in a few days. Enjoy your weekend. Thanks for listening.

[Altostrata]

Lamotrigine is not an antidepressant. It reduces nervous system reactivity.

 

You've been on and off so many drugs and taken Ativan occasionally, it's hard to tell if what you think was panic or anxiety might be drug side effects.

 

If you still have IBS symptoms, you might want to go on a non-irritating diet for a while, no spicy foods, no packaged foods, no artificial flavorings, no alcohol. You might want to cut out dairy to see if that helps.

[Jmizz]

I no longer have issues with ibs. However I try to eat relatively light as it is. 

 

Yesterday I took 25 waited an hour and took 25 again. Today I spaced it two hours. I’ve noticed all the intitial start up and updose symptoms are back, so I guess I’ll have to deal with this for a few days. For me it manifests as sinus like head pressure, nausea, dry mouth, and headache. So far it hasn’t seemed as bad as the initial updoses, but it’s there. I think I will benefit when my body gets used to 25 am 25pm, as I feel like I’m waking up in interdose withdrawal every morning. Itching on my legs and overall pretty shaky until I take the medicine. Does the spacing have to be 12 hours? Or could it be spaced like 7am-5pm? Once I get this accomplished I’m not messing with anything, my body needs a break for a while. 

 

[Altostrata]

When did the itching start?

 

Did you get these startup symptoms when you took the second dose of lamotrigine or from each dose?

 

Doses 12 hours apart is best.

[Jmizz]

I seemed to get a little itchy starting around 7-8pm at night. But then I take my trazodone and go to sleep. However this morning I was pretty itchy, especially on my shins, up until I took my first dose at 7:45am. I took my second dose at 9:45am and I noticed the nausea, dry mouth, head pressure, and sore neck muscles start around 11:30-12. When I intially began on 25 mg I would get these symptoms the first few days as the day went on all the way into the evening for a few days, then it settled until I went up up to 50mg and it was the same pattern. They aren’t immediate, it usually begins several hours after I take the medicine. I hadn’t felt these symptoms since the first few days on 50mg until the last couple days of spacing. Now that I think of it, I remember being itchy for a few days starting and updosing too. So maybe my body just has to get used to the medicine being at different levels in my system for a few days?

 

I also need to add I use smokeless tobacco. My habit has gotten worse throughout this process, and I’m sure then stimulant effect is hurting me. The activation feeling seems worse the last two days also 😞

[Jmizz]

Ok I’ve got more questions today: I’m going to my psych in a few hours to discuss meds.

 

So I read some of the threads and some stuff from Dr. Shipko that have been posted. This definitely seems like akathisia. It’s anxiety and restlessness I’ve never felt in my life, leading to ugly thoughts at times when it’s bad. Started 3 weeks after last lexapro dose. Been fighting it since. Being alone with my thoughts is something i used to cherish, and now seems nearly impossible.

 

can it cycle? Like if you keep busy and distracted can symptoms be better, and then something set it off again? I definitely do better when I’m distracted by things inside my comfort zone but downtime is unavoidable eventually.

 

does the fact that mine came on quick bode well for it eventually passing? I saw where he said late onset seems to be worse

 

is it possible lamotrigene dose is too high and the activating feeling is aggravating it and might settle when I accomplish getting my doses 12 hours apart?

 

is it possible I’m just going to have to take benzos pretty regular and hope this passes? if so should I discuss switching to a longer acting one?

 

It seems his only suggestions were reinstatement and benzos. I doubt very seriously y’all would recommend going back on lexapro at a low dose even though it’s only been 3 months.

 

i just have to figure out how to somewhat stabilize myself

 

Thanks in advance

 

also should I do a daily symptom timeline as I’ve seen some do? I can tell you though my worst times always center around time to myself with my thoughts.

 

 

 

 

 

[Sassenach]

Hi Jmizz

11 minutes ago, Jmizz said:

I’m going to my psych in a few hours to discuss meds

He will almost certainly want to change or updose a med to " make you better "

Your CNS needs stability, not change.

Alto is the best and her advice is based on years of study and anecdotal info. from this site.

14 minutes ago, Jmizz said:

It seems his only suggestions were reinstatement and benzos. I doubt very seriously y’all would recommend going back on lexapro at a low dose even though it’s only been 3 months.

We would not it is another change.

 

15 minutes ago, Jmizz said:

i just have to figure out how to somewhat stabilize myself

 

Nothing to figure out because you are now doing what is necessary.

It is only a month since your swap to Lamictal and two weeks since the updose.

Patience is needed here.

 

Sassenach

[Jmizz]

Thanks

 

Do you suggest taking ativan when I feel I absolutely need it? Or abstaining completely and just dealing? Trust me I definitely don’t want to cause another problem. I’ve got 3 days of work left and then im off for 2 weeks. Hopefully I can rest and be less stressed during that time period, but do you think taking 0.5 on those days would be ok? They are spaced by a day...so I’d take a day, off a day, take a day, off a day, take a day

 

also im certainly not going against anything alto is saying. I put more faith in her than any medical professional. I’m 100% following her plan and just using my psych to provide the medication I need.

[Sassenach]

As you are currently moving your lamictil doses it would be better if you can manage without.

Taking it every other day will mean it is very difficult to assess the cause and effect of each drug.

[Altostrata]

2 hours ago, Jmizz said:

is it possible lamotrigene dose is too high and the activating feeling is aggravating it and might settle when I accomplish getting my doses 12 hours apart?

 

Yes, those could be side effects from lamotrigine. Head pressure and nausea after a dose definitely are. Given the itching, my guess is the daily lamotrigine dosage overall is too high. (Could the itching be associated with trazodone? Or did it appear only when you started lamotrigine?)

 

If I were you, I'd cut down your two daily doses to 20mg each. You can do this by getting a prescription for 5mg tablets, to be taken in divided doses of 20mg (4 tablets) each, or getting lamotrigine compounded into custom tablets or a liquid. The liquid would give you greatest flexibility in dosage adjustment. In a pinch, you can make your own liquid, please see Tips for tapering off Lamictal (lamotrigine)

 

If you took benzos, you'd have to take them regularly, probably a longer-acting one, such as clonazepam or diazepam. Eventually, you'd have to taper off. I would give reduced lamotrigine a try first.

 

Yes, daily drug and symptom notes would be helpful, thanks for offering.

[Jmizz]

Psych appointment recap @Altostrata @manymoretodays @Sassenach

 

I got out of it what we needed alto. She’s prescribing split dose 25mg lamictal for me.

 

-threw more ativan at me

-suggested propranolol for akathisia symptoms (nope)

-said the akathisia should go away when the lexapro is out of my system completely (it’s been 3 months) lol

- told me I can just split trazodone to 25 for a bit whenever I decide to come off

-said the dose of lamictal I’m on should cause no issues coming off of (I took as cold turkey)

- told me ativan isn’t an issue except for people taking doses of like 4mg daily for some time

 

im in guys

yall are my doctors now

 

 

i just read your last response alto. So I’m editing this to respond. 

 

It is possible that the late night itching could be trazodone related. However the other day I had it in the morning also. 

 

I’ll get you a symptom list shortly.

 

 

 

 

 

[Jmizz]

I get the feeling it’s too much lamictal. How does the compounding work. You find a pharmacy that does it and then pay for it, I just left and she agreed to do 25 split dose. I don’t know if I could ask for 5mg after I just left. But I could try to ask.

 

symptoms today: 11-18

-6:00am wake

-7:45am take 25 mg of lamictal (didn’t notice itching this morning)

-7:45-9:30 felt ok lamictal seems relatively sedating

-9:30-10:45 home alone anxiety increases mostly due to being alone with thoughts went outside and calmed down

-10:45am take 2nd dose lamictal

-11:00-1:30 start feeling more activated towards 1pm

-1:45pm psych appointment, fight jitteriness and inner restless

-3:30pm get to moms to pick up son

-3:30-5:30pm stay at moms, shop online with her for wife bday and feel restless and overwhelmed...still feeling activated...during this two hours I start feeling nauseous, mild headache, slight sinus pressure...nothing seems as bad yesterday except nausea...realized I hadn’t eaten since 11:00am maybe made it worse...start feeling physical anxiety feelings of face flushing and tingling in back of head give in take 0.25 ativan

-6:00pm feel down bc I gave in to ativan and feel like it’s prob too much lamictal and wish I never went to 50mg

-6:30 feel a great deal better 

 

i may have just done/had too much to do today but this afternoon was rough

 

11-17 symptoms

-6:00am wake

-7:30a itching on legs

-7:45am take 25 mg lamictal

-9:45am take 25 mg lamictal

-12:00 in church feel head pressure, dry mouth, neck tension

-1-3 wife and son take nap, alone with my thoughts, anxiety/activation increases

-4-6:30 go outside and play with son try to keep mind off things, feeling jittery

-6:30 put drone together for son, feels hard to focus, slight left side headache, sort of overwhelmed

7:00 calm down somewhat til bedtime

-bedtime have bad dream for first time since first or second day on 50mg lamictal

 

Prior to 11-18 (today) I hadn’t take any ativan since 11-15