Jmizz: Lamictal taper suggestions

[Altostrata]

Since you started the 5mg dose at 2 p.m., are the "dose feels" stronger first thing in the morning?

 

You're getting your usual startup symptoms from the 2 p.m. dose.

[Jmizz]

Yes, @Altostrata for a few days it seemed the dose feels were worse in the morning. I haven’t noticed the past two days but I was busy both mornings, I’ll pay attention tomorrow.

It all makes sense now. I’m reacting to the lamictal in a lesser fashion the same way I did after I drank on lexapro on 10 and 20mg.  It’s like the initial start up symptoms start all over. On lexapro especially at 20mg I was driven insane by the jitteriness. Now Lamictal makes me pretty jittery an hour and 1/2 or so after I take it and that 2pm dose increases it but it’s not at the level of when it happened on lexapro. Ughh 4 sips. At least I know what’s happening now and i won’t panic taper off in 6 weeks like I did with lexapro. Wow I stabilized twice on lexapro after my adverse reaction to Zoloft and even though I was weary of drinking, I was told it was just a liability warning on the bottle. Frustrating!

[Jmizz]

@Altostrata

 

5:30wake (work) slept great

6-8 had a busy morning at work, led to a little forced exercise, didn’t feel dose feels bc I was preoccupied...had a little stress overwhelm as a medical patient was combative and had to watch police tase him. Made it through.

8-15mg water 

9:30-11activation jitters/inner restlessness/facial numbness flush

noon-some anxiety/ate lunch and it helped some

12-2 kinda waves of activation anxiety, manageable, move around a little, slight nausea/slight dry mouth

2pm-5mg dispersible

3-5-activated anxiety/jitters

6-dinner

6:30-8 feel pretty good

8-17.5mg water

9-Low grade chest squeezing type anxiety, shallow breathing 

9:30-traz50mel5

 

mood was good all day, maybe one or two dips when physical symptoms kicked up...the anxiety/activation still sucks...felt pretty good window before nighttime dose for the second day in a row 🤞🏻 Hopefully soon I won’t feel the medicine again.

 

 

 

[Jmizz]

@Altostrata

 

530-wake

6-8 ok/itchy

8-15mg water

9:30-11:30- activated, some nausea, tingly skin, head sensations, jittery, flush numb face

noon- lunch

12-2 tingly, some nausea, itchy on legs before 2pm dose 
2pm-5mg dispersible

2-5:30- head pressure, some nausea, slight headache

6-dinner

7-8 dose feels

8-17.5 mg water epsom bath

8-9 feel ok

9-50mg trazadone 5 melatonin 

 

same symptoms I had moving my 25 dose from morning to night, mentally I feel ok the past couple days, just gotta settle into different levels of the drug diff times of day it seems

 

 

 

[Altostrata]

Can you hang in there? The startup symptoms settled down before, right?

[Jmizz]

@Altostrata

 

They did yes.

 

right now the morning dose is hitting me hard. I guess bc of the 12 hour gap from night to morning dose. If this would settle down, I’m feeling pretty good mentally the past few days.

[Altostrata]

Looks like you started the 5mg mid-day dose on January 4. I'd give it another 3 days.

 

It looks like you might do better with weighting the dose towards the evening, to provide coverage overnight and reduce the "startup" sensation of the first morning dose. To start, I would move 2.5mg from the morning dose to the evening dose: doses would be 12.5mg, 5mg, 20mg

[Jmizz]

@Altostrata

 

I’ve been doing 5mg midday dose since December 30th. I was doing water solution until the 4th when I started the 5mg disersibles

 

should I give my current situation a few more days or do you recommend me trying this switch now?

 

that would be beneficial bc then I could get a pill cutter and half my 25s for my morning doses. And that way I’d only have to mix once a day in the evening.

[Altostrata]

Yes, you could try moving a little bit of the morning dose to the evening right now. Hopefully, this will reduce the "startup" symptoms in the earlier part of the day and give you coverage overnight.

[Jmizz]

@Altostrata

 

so far today:

 

6-8 felt ok maybe a touch of dosey shakes

8-dose 15mg

9-1130 activated pretty bad, some nausea and dry mouth, sore neck, slight headache

12-145 I feel a little better once that morning dose wears off some, approaching 2 start getting dosey

 

the itching didn’t happen today

[Altostrata]

Yes, I'd lower the morning dose and move a bit to nighttime. Good to hear itching stopped.

[Jmizz]

@Altostrata

 

im sure you’ve already made this deduction by reading through my symptoms patterns. It appears that I metabolize the Lamictal quickly and I was getting interdose withdrawal between Lamictal doses. You have been doing this a long time. I was reading where it says even distribution of dosages and times between are the best ways to rectify it. However I’m inclined as you are to believe I need a bigger dose in the evening dose To get me through the night. I’m curious however if eventually maybe a 10-10-17.5 would be beneficial. I’ll see how the next few days go. Today is my second day of 12.5 then 5 then 20. The startup symptoms weren’t as bad yesterday or today. I did wake up at 4am this morning with a headache, but that seems to be the norm with almost all changes. I’ll keep you posted.

[Altostrata]

27 minutes ago, Jmizz said:

I’m curious however if eventually maybe a 10-10-17.5 would be beneficial.

 

It's possible. We make small changes and then step back to see what works. Lamotrigine dosing is very individual.

 

No startup symptoms with that first dose is a good sign.

[Altostrata]

How are you doing, Jmizz?

[Jmizz]

@Altostrata

hey alto. Thanks for checking on me. I’ve been meaning to come on and update but I was enjoying a couple days where things were more manageable than they have been in a while and mentally I was feeling pretty good. I thought I’d try to give myself a mental break from focusing all day on withdrawing. There were definite improvements in mood stabilization and I’ve been able to sit down at times even though I’m still not relaxed it’s not as bad as I had been. I’m cautiously optimistic though bc often times with med tweaks I’ll feel good for a few days and then have a setback. I’m horrible about daily notes and need to be better.
 

basically since we last spoke I had a couple days of physical stuff and mentally feeling pretty good. Those first few days of 12.5-5-20 went like this.

 

6-7wake with pretty intense soreness in my neck and back

8-dose 12.5mg 1/2 tablet

8-9 I’d get a little itchy and feel a little jittery closer to 9am then it would kind of die off for a bit

11-12 usually about 3-3.5 hours from dose I’d get a little activated uncomfortable for a bit and a headache and some of the facial numbness 

12-2 I seemed to get a decent window as the morning dose wore off until I started feeling like I needed my next dose

2-5mg dispersible

3-4 it would kinda follow the morning pattern of feeling the medicine hitting 

4-530 id get a little activated uncomfortable again, a few days I had the head pressure during this time 
6-8 I’d generally feel relatively well approaching my 8pm dose.

 

The last couple days the physical stuff hasn’t been as bad but I seemed to get pretty fatigued following the morning and afternoon doses.

 

I also had a couple nights where I got about 5 hours sleep instead of 7-8, not sure if the fatigue is related to that. One night I just didn’t sleep well and the other night I was up watching the national championship football game til around midnight (Monday). My favorite team was playing and I found it over stimulating so I had a tough night anxiety wise but I knew the trigger and I dealt with it.

 

 The next couple days I’ll write you some hourly symptoms. i really don’t enjoy how Lamictal makes me feel. I’m not sure if it’s Lamictal itself or if Lamictal just aggravates my ssri withdrawal symptoms. I know patience is needed here but I’m so ready to try and at least start working towards a lower dose.

 

 

[Altostrata]

When your pattern settles down, you might reduce the morning dose to 12mg, keep notes about the effect.

[Jmizz]

@Altostrata

thanks, I will, I’ll provide the next few days, detailed symptoms list.

[Jmizz]

@Altostrata

 

1-16-19

5am-wake

7-8am slightly dosey

8am- 12.5 mg

11am-1pm- a little tremory/shaky/slight nausea/slight dry mouth

2pm-5mg

3pm-upper back/neck tension

4-530- a little tremory shaky

6-8 pretty much just muscle and joint pains

8pm- 20mg

9-epsom bath/traz 50 melatonin 5

10- sleep (bad dreams, slept good aside from waking at 2:45 and falling back asleep)

 

1-17-19

530-wake work

6-8 muscle and joint pain

8-12.5mg

9-some activation jitters

9-1130 sore upper back

1130- pretty activated, jittery, head sensations

12-2 mild headache/mild head pressure/ little antsy

2-5mg

3-fatigue/some jitters

6-8- headache, joint pain, upper back and neck tension/ seemed dosey before 8

8-20mg

8-9 dosey feels eased/headache continues, still sore muscles and joints

9pm-traz50 Mel 5

 

[Altostrata]

Looks to me like the 20mg dose at night is settling in, but 12.5mg might be too much in the morning.

[Jmizz]

@Altostrata

 

this is all still pretty confusing to me. Does the drug even matter, or is it just the issue with destabilization regardless of which drug it comes from? I’m functioning, I’m extremely grateful for that after reading how bad some people are having it. I’m going to work and raising a 2 year old with another on the way. But man, I guess I’m just struggling with not knowing really exactly why I’m feeling bad at times? Is it still SSRI withdrawal or is it side effects from Lamictal, or is it withdrawal sensitivity causing the Lamictal side effects? 
 

today was a relatively good day. It seems days at work are harder on me as far as physical symptoms. I guess even though I don’t feel like it, there’s a certain level of stress there, and sleeping away from home probably doesn’t help. I can’t deny that I’m making progress, I just feel like I’m not bc I hate taking this lamotrigene and I know from what I learned from you guys, I’m far to fragile to try and get off of it.

 

today 

6am wake 

8am-12.5mg

no real issues today between 8am-2pm except fatigue and maybe a touch of activation 

2pm-5mg

330-6 the body aches came back/upper back and neck, slight headache, slight head pressure 

7-8 felt pretty good 

8-20mg

9-epsom bath 50 traz 5 melatonin

 

the 20 seems to maybe have been wiring me before bed lately, but I also slept at work for 3 of the last 5 nights. I’m off for 4 days so I’ll see how the next few nights go.

[Altostrata]

Good questions. Your daily record shows some adverse effects from lamotrigine, but if you look back at earlier posts, you will see what appears to be withdrawal symptoms are very much reduced.

 

It's also possible trazodone is causing some symptoms during the day.

 

You've only been using a distributed lamotrigine dose for maybe 6 weeks. You had much worse adverse reactions when you were taking a single dose.

 

My guess is once we get your schedule set, you'll be able to reduce the lamotrigine, reducing whatever adverse effects it has.

[Jmizz]

@Altostrata

 

Ok a few more questions and comments.

 

so do most people become more sensitive as far as allergies in withdrawal. It’s not a big issue for me, I’ve just noticed at times, i seem to get itchy eyes. Could be the lamotrigene, it’s manageable, I was just curious.
 

im wondering if maybe fish oil would help me with the body and joint pain. It’s awful in the morning, usually goes away an hour or so after my morning dose and then comes back to a lesser degree in the evening before my 8pm dose. I feel fortunate that this is what’s been bugging me the most the past week.

 

today was pretty good

 

i slept later than usual, I take this as a good sign

 

7:30- wake, prob could have slept longer but the aching woke me up. I’m interpreting this as being caused by the 12 hour gap in dosing. That’s how it seems anyway

8-12.5 mg

9-1-a friend brought his son to play with mine, felt a little overwhelmed a couple times, feeling like I needed to provide entertainment but overall it was good. This mainly occurred during the 3-4 hour post dose window. I felt fatigued pretty bad around noon to 2 but this is likely due to the company and being slightly out of my withdrawal comfort zone.

2-5mg
4-5- had the usual ramp up feelings, I’m learning to ride it out well and also they seem more manageable as days go on.

6-8 no issues to speak of, maybe slightly achy and a touch of head pressure

8-20mg

9-epsom salt/50 traz 5 melatonin

10-sleep

 

i thought a lot about what you said. I think you nailed it. I believe prob 80% of what I’m dealing with now, is physical effects of lamotrigene. The withdrawal symptoms seemed to have improved substantially. I feel like myself mentally prob 85-90% of the day as long as I take it relatively easy and stay in my comfort zone. I seem to be learning to deal with the moments I do get anxious better, as I have a better understanding of what’s going on now. Man it sure feels good to seem like myself again, even if this just ends up being a window, at least I feel like progress is happening. Tinnitus never really goes away, clenching is still there. I only get anxious now when I’m outside my comfort zone, this is a big improvement from being anxious sitting in my own house. I haven’t felt depression much in quite a few days, and if I do it passes quick. I’m able to sit around and browse my phone and watch tv again. I still don’t fully relax though but I’m sure this will improve when I eventually start lowering the lamotrigene dose and/or get used to finally having some consistency. 

feeling hopeful alto! And your help means the world to me. 

 

[Altostrata]

It sounds like those aches are interdose withdrawal from lamotrigine overnight, or the lamotrigine is wearing off and your withdrawal symptoms are breaking through. You might move 0.5mg from the morning dose to the evening dose, keeping notes as usual.

 

Please note when you have itchy eyes. Are you allergic to dust or pollen?

 

Yes, you might add fish oil and magnesium supplements, see
https://survivingantidepressants.org/index.php?/topic/36-king-of-supplements-omega-3-fatty-acids-fish-oil/
https://survivingantidepressants.org/topic/15483-magnesium-natures-calcium-channel-blocker/

 

Try a little bit of one at a time to see how it affects you. You are getting some magnesium from Epsom salts baths, be careful not to overdo it -- you'd get loose stools with too much magnesium.

 

[Jmizz]

@Altostrata

 

ive  had allergies most of my life, seasonal mainly, change in weather. I’ve seemed to react real bad to cutting the grass the last two times, as the grass is mostly dead so it creates a pretty good dust. 
 

the aches got pretty bad in the morning starting when I got used to my 3x a day dosing, it definitely seems like it’s interdose by the time I wake up. The aches come in a lesser forms before my 2pm and 8pm doses also. But the aches/sinus’s allergy symptoms (itchy eyes, headaches, and pressure) are my only real complaints lately, some fatigue at times. Anxiety is way down for the most part, and depression fits are all but gone. I wish I didn’t metabolize this stuff so fast.  
 

I’ll make note of the itchy eyes in my daily notes from now on.

 

ill prob try the fish oil first as I’m getting some mag already from Epsom salts. 

[Altostrata]

If I were you, I'd try allergy eye drops. I like the ketotifen drops, such as Alaway.

 

I wonder if those "dosey" feelings might not fade as your system gets used to a lower overall lamotrigine dose. I'd still move 0.5mg from morning to night.

[Jmizz]

@Altostrata

 

thanks for the eye drop advice. I’ll look into it. I have two more days to work then I’m off for 3 weeks. I’ll prob experiment with fish oil during this time. 
 

today at work was a weird day so my symptom pattern could have been thrown off from a number of things.

 

5:45 wake (aches and pains not as bad today)

6-arrive at work, immediately sent to a building fire

6-8 busy with fireground operations, no issues to speak of

8-9 during this time I felt like maybe my body was telling me it was dose time (these feelings haven’t been as bad for the last week)

9-was close to 9 before I could take my 12.5mg 

10:30-12 I felt a little more activated than I have been, possibly bc my dose was later

12-2 felt ok, some aches and pain, slight headache coming on and a little itchy on my legs before 2 (haven’t felt itchy in a while)

2-5mg

3-5- some anxiety possibly because I cooked at work today, headache worsens

5-8 headache continues

8-20mg

8-9 headache continuing only real issue

9-traz50 melatonin5

 

im going to do the math tonight and figure out the best way to take 12mg in the morning and 20.5 at night and begin tomorrow.

 

i only seem to get the bad headaches at work, I guess maybe from added stress?? Even tho I don’t feel particularly stressed, I guess maybe just being around a lot of people and not being in control of my surroundings.

 

symptoms wise I think maybe not being on time with the morning dose kinda threw me off a little today, hoping tomorrow I’m back on track.

[Altostrata]

It seems you're really sensitive to your lamotrigine timing. 

 

Does your headache at work start in the morning?

 

I might suggest lamotrigine XR except it the lowest dosage is 25mg and it might make you itch. You might be able to take it with the 5mg tablet. 

 

The switch might be rocky, though.

[Jmizz]

@Altostrata

 

the headache usually starts around lunch at work and progresses throughout the day. It could be bc sometimes at work mid morning I try to relax on the couch and if I get close to falling asleep and wake up it always gives me a headache it seems. 
 

explain how the dosing would work if I switched to XR. Would I take it at night and then take 5 at 8am and 5 at 2pm with dispersibles. And how would I ever be able to go off of it?

 

It seems as tho the joint and muscle pains may have been due to the increase in the night time dose, as the days go by the pains have seemed to subside and sleep has been better at night.

[Jmizz]

@Altostrata

 

ill also add the headache seems to be stress related and often coincides with jaw clenching. I think my headaches come at work bc obviously being at work is more stressful than being at home and in control of every move I make throughout the day. 

[Altostrata]

Seems to me that could be too much lamotrigine in the morning.

[Jmizz]

@Altostrata

 

even though I rarely get headaches when I’m off work? I mean it makes sense bc the 20-20.5 mg at night doesn’t seem to bother me. I think it’s just maybe too much of a jump after the long layoff overnight that causes me the problems between 1030-1230 every day.

 

im hesitant about the time release just bc I feel like I’m feeling better in so many ways and nervous to change. Could it just be windows and waves? I’m noticing a pattern of the days I’m forced to wake up at 5:30 for work or to come home from work seem to be rough. Could it just be waves maybe produced by less sleep those nights?

 

i did 12 this morning And 20.5 this evening. I’m hesitant to try the XR bc I know that’s gonna be tough to get used to and make it difficult come tapering time. I also had some days this past week where I felt like I was so close to feeling pretty good almost all day. Maybe if I can get that morning dose down a tad, I won’t have the shaky periods during the day. I don’t know, trying not to get frustrated. I have a long stretch off work for 3 weeks starting Monday. So maybe consistency during that time period will help??

[Altostrata]

Hmmmm....good point. Is there a way you can use conscious relaxation techniques at work? Jaw and neck tension can cause tension headaches.

 

Yes, if you can work with divided doses of the immediate-release lamotrigine, I would stick with it rather than make a drug change.

 

Given where you were a few months ago, you're doing pretty well, correct?

[Zofia]

Hi Jmizz

 

I've just read your story (Altostrata sent it to me as we seem to take the same drugs). I see you're doing daily updates of symptoms, etc. (something I can't even contemplate) and really paying attention to your body, good work. So basically I just wanted to say: hang on in there, I'm sure you'll pull through! Crossing my fingers for you and good luck!

[Jmizz]

Hi @Zofia thank you for the kind words, sorry you have found yourself here under these circumstances. You’ve come to the right place, it’s a struggle, I’m still in the thick of the battle but I’m making progress slowly but surely. @Altostrata is amazing, she can give you some good advice. Best wishes to you, any questions feel free to ask.

 

[Zofia]

Thanks Jmizz, I'm also fighting and hope to win one day.

[Jmizz]

@Altostrata

 

i understand the windows and waves pattern. But this pattern happens while still on medication too as your body tries to stabilize? Our shift at the firehouse goes like this:

24work

24off

24work

24off

24work

96(4days) off

repeat

i had a good run on my last 4 days off, sleeping good, feeling good mentally, I think I was still adjusting to the morning drop and evening bump but mentally I was doing well. I’m assuming you’d call this a window. Didn’t feel much in the way of what I consider withdrawal symptoms as you pointed out the other day. This shift at work has been pretty taxing. It happens, I can’t really avoid it. I try to treat myself gently in every way I can but I think I have a little wave going on right now that was brought on by a few particularly stressful work situations, one being in the middle of the night and leading to only getting about 3 hours of sleep last night. 
 

I guess I just need to hear that this is normal. I’m about to have about 23-24 days off work after tomorrow. I’ll give you a symptoms list this evening for the last couple days.