csm2014: Lamictal question

[csm2014]

My first thought is to hold where you are at the 25 mg and ride it out, if you can. Alternatively it would probably be okay to go a bit higher than that but I think all the way to 50 might be so big a jump it would just make you worse. If you want to consider going up a bit more I'd say try 30 (you will probably have to use a scale or dissolve the tablets, we have extensive info on how to do that in the Tapering area).

 

And then take notes daily of what time you take your meds, all of them, and supplements, and notes of when you have symptoms and what time, ranking them on a scale of 1 to 5 or so, and keep that journal.

 

Since your situation is complex it is all the more important to make only small changes at a time, to only change one thing at a time, and to keep careful observations of what happens when you change anything, because everything interacts. (I am pretty sure that my lamictal and thyroid meds and benzos all affect me in ways that work together and a change in any one affects the effects of all of them.)

 

tl;dr: I think it might be best to stay where you are or make only a small change. Keep track of everything.

I have kept track of everything on a spreadhseet. The major worry I have in dragging out this unexpected attempted Lamictal restabilization is that it will extend the time I'm on Klonopin unless I start tapering that as well which all have told me not to attempt at this time. You're right about all these meds/supps interacting; that's how I got into this mess in the first place! The difference between me and others is that I haven't been on these psych meds that long (10-14), so at least that's one good thing in this hell - and that's why I am concerned about staying on the Klonopin much longer. My taper off these drugs should not be longer than I used them. I am on my 8th day of reinstating the Lamictal. No relief yet.

 

Thoughts?

[Altostrata]

Hello, csm.

 

.....

I seem to have a 12hr cycle in which I feel better from about 6-8p-6-8a; crappy from 6-8a to 6-8p. Peaks worst @ around 4-5p. Today, same thing. Started getting worse again around 2p - anxious/depressed/moody/fatigued/achey. Can't understand how being off it for only 7 days could've destabilized me and why I'm not restabilizing faster. Thoughts?

 

 

To me, this indicates that something you're taking is causing symptoms. Lamotrigine has a half-life of about 22 hours, it could be fading out in the evening.

 

Are you taking any other drugs? For thyroid?

 

How about B vitamins? What's in your supplements?

 

For information about titrating lamotrigine: Tips for tapering off Lamictal (lamotrigine)

[csm2014]

Hello, csm.

 

.....

I seem to have a 12hr cycle in which I feel better from about 6-8p-6-8a; crappy from 6-8a to 6-8p. Peaks worst @ around 4-5p. Today, same thing. Started getting worse again around 2p - anxious/depressed/moody/fatigued/achey. Can't understand how being off it for only 7 days could've destabilized me and why I'm not restabilizing faster. Thoughts?

 

To me, this indicates that something you're taking is causing symptoms. Lamotrigine has a half-life of about 22 hours, it could be fading out in the evening.

 

Are you taking any other drugs? For thyroid?

 

How about B vitamins? What's in your supplements?

 

For information about titrating lamotrigine: Tips for tapering off Lamictal (lamotrigine)

 

I actually feel better a few hours prior to bedtime and take my Lamictal dose right before bed. All my meds are listed in my signature below. I just posted my supp summary in there as well.

 

I really want to get off all psych meds (Lamictal and Klonopin) so I can continue to address the real causes - hormones imbalances (mainly low thyroid function which is one of the reasons I'm in this mess to begin with). I definitely need to take a special methylated form of B vitamins because of my MTHFR genetic mutation. Thyroid numbers are looking better now though than when this crash started, but still not there. Doc doesn't want to add more thyroid hormone for fear it would over-stimulate my nervous system while tapering the meds. I see his point, buit then other docs say not treating thyroid with enough hormopne will make the symptoms worse. Catch-22 is what drives me nuts. I just want to move forward and out of this mess.

[Fresh]

Hi csn . . . if your thyroid numbers are improving I'd be content to stay on your current dose of Armour.     My level was low and has improved after starting Eutroxig.

Yay to your doctor NOT wanting to add more.

LOL  @  MTHFR genetic mutation . . . a spent a while trying to figure out what that was.   ; )

Fresh

[Altostrata]

What is the timing of when you take your drugs and supplements and your symptoms? What is your daily symptom pattern?

[csm2014]

Hi csn . . . if your thyroid numbers are improving I'd be content to stay on your current dose of Armour.     My level was low and has improved after starting Eutroxig.

Yay to your doctor NOT wanting to add more.

LOL  @  MTHFR genetic mutation . . . a spent a while trying to figure out what that was.   ; )

Fresh

They don't call it a MTHFR mutation for nothing. It can be the cause of some very serious conditions depending on how it is expressed which is different for everyone: www.mthfr.net

[csm2014]

What is the timing of when you take your drugs and supplements and your symptoms? What is your daily symptom pattern?

For the most part I take my meds 12h apart, with the exception of thyroid which needs to be taken at least 3h away from all other meds/supps/food. Most supps are taken with and some between meals that cannot be taken with food (like iron). Like I mentioned before, I seem to have a diurnal 12h symptom cycle from waking (when cortisol peaks) to early evening and then from there, another 12h cycle of down-regulation of the stress hormone response. This is not always the case, but what I observe mostly these days during my experience while on these meds.

[csm2014]

Hi csn . . . if your thyroid numbers are improving I'd be content to stay on your current dose of Armour.     My level was low and has improved after starting Eutroxig.

Yay to your doctor NOT wanting to add more.

LOL  @  MTHFR genetic mutation . . . a spent a while trying to figure out what that was.   ; )

Fresh

My FT3 and FT4 levels have improved, but TSH is still too high which means I'm still hypo which can still cause hypo symptoms (depression, anxiety, etc.). Still not 100% out of the woods yet. Too much or too little thyroid hormone can cause severe mental illness. A lot of the reason too many people are put unecessarily on psych meds which do nothing to address the underlying cause and only make one worse.

[cymbaltawithdrawal5600]

I put as many drugs and supplements from your OTC supplement summary as it would load into the drugs interactions checker and here are the results:

 

Interactions between your selected drugs

clonazepam ↔ lamotrigine

Applies to: Klonopin (clonazepam), Lamictal (lamotrigine)

Using clonazePAM together with lamoTRIgine may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

clonazepam ↔ losartan

Applies to: Klonopin (clonazepam), losartan

Losartan and clonazePAM may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

clonazepam ↔ carvedilol

Applies to: Klonopin (clonazepam), Coreg (carvedilol)

Carvedilol and clonazePAM may have additive effects in lowering your blood pressure. You may experience headache, dizziness, lightheadedness, fainting, and/or changes in pulse or heart rate. These side effects are most likely to be seen at the beginning of treatment, following a dose increase, or when treatment is restarted after an interruption. Let your doctor know if you develop these symptoms and they do not go away after a few days or they become troublesome. Avoid driving or operating hazardous machinery until you know how the medications affect you, and use caution when getting up from a sitting or lying position. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

clonazepam ↔ valerian

Applies to: Klonopin (clonazepam), Valerian Root (valerian)

Using clonazePAM together with valerian may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

lamotrigine ↔ valerian

Applies to: Lamictal (lamotrigine), Valerian Root (valerian)

Using lamoTRIgine together with valerian may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

clonazepam ↔ kava

Applies to: Klonopin (clonazepam), kava

Talk to your doctor before using clonazePAM together with kava. Combining these medications can increase the side effects of clonazePAM including drowsiness, confusion, incoordination, difficulty concentrating, and breathing problems. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

lamotrigine ↔ kava

Applies to: Lamictal (lamotrigine), kava

Using lamoTRIgine together with kava may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

valerian ↔ kava

Applies to: Valerian Root (valerian), kava

Using valerian together with kava may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Switch to professional interaction data

No other interactions were found between your selected drugs.
Note: this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs that your selected drugs interact with

• kava interacts with more than 200 other drugs.
• losartan interacts with more than 200 other drugs.
• niacin interacts with more than 80 other drugs.
• niacinamide interacts with more than 50 other drugs.
• vitamin a interacts with more than 10 other drugs.
• vitamin e interacts with more than 100 other drugs.
• 5-HTP (5-hydroxytryptophan) interacts with more than 60 other drugs.
• CoQ10 (ubiquinone) interacts with 3 other drugs.
• Coreg (carvedilol) interacts with more than 400 other drugs.
• Klonopin (clonazepam) interacts with more than 300 other drugs.
• Lamictal (lamotrigine) interacts with more than 200 other drugs.
• NAC (acetylcysteine) interacts with 3 other drugs.
• Valerian Root (valerian) interacts with more than 200 other drugs.
• Vitamin D3 (cholecalciferol) interacts with more than 50 other drugs.
• Vitamin K (phytonadione) interacts with 7 other drugs.

Interactions between your selected drugs and food

losartan ↔ food

Applies to: losartan

If you are taking losartan you should avoid potassium-containing salt substitutes or over-the-counter potassium supplements without first talking to your doctor. This can cause high levels of potassium in your blood. High levels of potassium can cause weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs. Call your doctor at once if you have any of these symptoms. In some patients grapefruits and grapefruit juice may decrease the efficacy of losartan. Grapefruits and grapefruit juice should be avoided if an interaction is suspected. Orange juice is not expected to interact.

 

Of course, you may not be taking all of these supplements, right? I notice that the last one, for potassium and losartan has a moderate caution. I did not put your potassium into the checker.

[csm2014]

I put as many drugs and supplements from your OTC supplement summary as it would load into the drugs interactions checker and here are the results:

 

Of course, you may not be taking all of these supplements, right? I notice that the last one, for potassium and losartan has a moderate caution. I did not put your potassium into the checker.

Appreciate the effort; have a tab continuously open on this myself since things change all the time, so I'm fully aware of possible interactions. They are moderate at best. I can actually use the increased hypotensive and anxiolytic effects to my advantage by combining some of the BP and psych meds. I no longer use kava or valerian as I didn't like the effects + they are GABA agonists, act similarly to benzos (can build tolerance just like benzos) and can make the benzo taper worse when that time comes. I take potassium citrate as i had a very painful kidney stone a couple years back. My potassium levels continue to remain within range as i don't overdue it.

[csm2014]

Had a near perfect window for a few hours later in the day and all night yesterday that I could only consider a good sign toward future improvement. The only thing I can recall doing different was that I fasted for a long while between meals.

[Altostrata]

csm, please give more detail about the times you take your drugs and your symptom pattern.

[csm2014]

csm, please give more detail about the times you take your drugs and your symptom pattern.

Sorry, will repost with more detail:

 

For the most part I take my meds(Coreg/Losartan/klonopin) 12h apart (once @ noon & then again within an hr if midnight; Lamictal is taken last right before bed), with the exception of thyroid which needs to be taken at least 3h away from all other meds/supps/food (7-8a). Xarelto is taken with my dinner meal. Most supps are taken with and some between meals that cannot be taken with food (like iron). Like I mentioned before, I seem to have a diurnal 12h symptom cycle from waking (when cortisol peaks) to early evening and then from there, another 12h cycle of down-regulation of the stress hormone response. This is not always the case, but what I observe mostly these days during my experience while on these meds.

 

The symptoms start as well as peak when I first wake up (depression, negative thoughts of doom, anxiety about my life, palpitations, feeling the urge to urinate and defecate, & blood pressure is always highest upon rising as well. I had a milder version of the symptoms before I started meds but now they are more pronounced with the meds. The same symptoms slowly dissipate over the course of the day and in most cases almost disappear by the late evening. Vigorous exercise and sweating really seems to help me get out of this funk. At least until the next cycle. Hard to say how much of it is related to withdrawal, low thyroid, low or high adrenal, another drug interaction, supplement, or something unknown. All I know is that I was better before completely tapering off.

[Altostrata]

 

I put as many drugs and supplements from your OTC supplement summary as it would load into the drugs interactions checker and here are the results:

 

Of course, you may not be taking all of these supplements, right? I notice that the last one, for potassium and losartan has a moderate caution. I did not put your potassium into the checker.

Appreciate the effort; have a tab continuously open on this myself since things change all the time, so I'm fully aware of possible interactions. They are moderate at best. I can actually use the increased hypotensive and anxiolytic effects to my advantage by combining some of the BP and psych meds. ....

 

 

No, it doesn't work like that, the combined "moderate" effects can be too much and interfere with the proper working of your body.

 

 

csm, please give more detail about the times you take your drugs and your symptom pattern.

Sorry, will repost with more detail:

 

For the most part I take my meds(Coreg/Losartan/klonopin) 12h apart (once @ noon & then again within an hr if midnight; Lamictal is taken last right before bed), with the exception of thyroid which needs to be taken at least 3h away from all other meds/supps/food (7-8a). Xarelto is taken with my dinner meal. Most supps are taken with and some between meals that cannot be taken with food (like iron). Like I mentioned before, I seem to have a diurnal 12h symptom cycle from waking (when cortisol peaks) to early evening and then from there, another 12h cycle of down-regulation of the stress hormone response. This is not always the case, but what I observe mostly these days during my experience while on these meds.

 

The symptoms start as well as peak when I first wake up (depression, negative thoughts of doom, anxiety about my life, palpitations, feeling the urge to urinate and defecate, & blood pressure is always highest upon rising as well. I had a milder version of the symptoms before I started meds but now they are more pronounced with the meds. The same symptoms slowly dissipate over the course of the day and in most cases almost disappear by the late evening. Vigorous exercise and sweating really seems to help me get out of this funk. At least until the next cycle. Hard to say how much of it is related to withdrawal, low thyroid, low or high adrenal, another drug interaction, supplement, or something unknown. All I know is that I was better before completely tapering off.

 

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

 

My guess is the drugs you take at night are causing "depression, negative thoughts of doom, anxiety about my life, palpitations, feeling the urge to urinate and defecate, & blood pressure is always highest" in the morning. They are all "brakes"; they're slowing your functions down too much, you're getting a paradoxical reaction.

 

You're taking two blood pressure drugs at night, are they both necessary at the dosage you take? You need to review these with your doctor.

 

Sounds like the lamotrigine is stabilizing, that's good.

 

[csm2014]

 

 

I put as many drugs and supplements from your OTC supplement summary as it would load into the drugs interactions checker and here are the results:

 

Of course, you may not be taking all of these supplements, right? I notice that the last one, for potassium and losartan has a moderate caution. I did not put your potassium into the checker.

Appreciate the effort; have a tab continuously open on this myself since things change all the time, so I'm fully aware of possible interactions. They are moderate at best. I can actually use the increased hypotensive and anxiolytic effects to my advantage by combining some of the BP and psych meds. ....

 

 

No, it doesn't work like that, the combined "moderate" effects can be too much and interfere with the proper working of your body.

 

 

csm, please give more detail about the times you take your drugs and your symptom pattern.

Sorry, will repost with more detail:

 

For the most part I take my meds(Coreg/Losartan/klonopin) 12h apart (once @ noon & then again within an hr if midnight; Lamictal is taken last right before bed), with the exception of thyroid which needs to be taken at least 3h away from all other meds/supps/food (7-8a). Xarelto is taken with my dinner meal. Most supps are taken with and some between meals that cannot be taken with food (like iron). Like I mentioned before, I seem to have a diurnal 12h symptom cycle from waking (when cortisol peaks) to early evening and then from there, another 12h cycle of down-regulation of the stress hormone response. This is not always the case, but what I observe mostly these days during my experience while on these meds.

 

The symptoms start as well as peak when I first wake up (depression, negative thoughts of doom, anxiety about my life, palpitations, feeling the urge to urinate and defecate, & blood pressure is always highest upon rising as well. I had a milder version of the symptoms before I started meds but now they are more pronounced with the meds. The same symptoms slowly dissipate over the course of the day and in most cases almost disappear by the late evening. Vigorous exercise and sweating really seems to help me get out of this funk. At least until the next cycle. Hard to say how much of it is related to withdrawal, low thyroid, low or high adrenal, another drug interaction, supplement, or something unknown. All I know is that I was better before completely tapering off.

 

 

Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic.

 

My guess is the drugs you take at night are causing "depression, negative thoughts of doom, anxiety about my life, palpitations, feeling the urge to urinate and defecate, & blood pressure is always highest" in the morning. They are all "brakes"; they're slowing your functions down too much, you're getting a paradoxical reaction.

 

You're taking two blood pressure drugs at night, are they both necessary at the dosage you take? You need to review these with your doctor.

 

Sounds like the lamotrigine is stabilizing, that's good.

 

Here is my (hopefully) saved list of all interactions of meds and supps: http://www.drugs.com/interactions-check.php?drug_list=369-0,955-0,2554-0,1339-0,3123-0,1489-0,1502-0,1665-0,1711-0,1712-0,1786-0,2052-0,2682-0,2189-1435,1665-14454,662-10257,531-266,2503-12466,655-14129,1077-13327,703-357,1430-848,97-4252,1749-15695,2179-5792,2010-3741,1972-3743,646-5790,1868-16217,3332-15382&types%5B%5D=major&types%5B%5D=minor&types%5B%5D=moderate&types%5B%5D=food&professional=1

 

Already reviewed my meds regimen and w/ more than one doc; both advised that taking the two BP meds at same time is ok. I get no paradoxical reaction. When taken with the Klonopin, sometimes the effect makes me slightly drowsy, but don't notice any other side effects. The Lamictal I take away from one another and right before bed. The thyroid I take early a.m. 3 hrs away from ANY meds or supps or even food.

 

Bottom line: As I have practiced a holistic lifestyle for nearly 35 years and never used anything more than an occasional anti-inflammatory in that time, I really hate all these meds and want off them (which has added to my worry/anxiety/discomfort), especially the psych meds. I have already started with the Lamictal. Next will be the the Klonopin. Then I will start on the BP meds again (unless I really need them) and possibly even the blood thinner (Xarelto) unless it's determined I have genetic thrombophilia (which has never been confirmed, by the way).  The only med I will stay on for sure is for thyroid. Worst case, that + 1 blood pressure med. And then I can get hopefully back to my life again. 

 

And yes, I finally stabilized and have been back to feeling pretty much myself the last 6 days straight @ 25mg Lamictal!  . I no longer experience the hot flashes and all of the other symptoms have lessened. I may want to hold for a few more days before re-tapering, albeit MUCH slower and have already noticed my doc on this. Hopefully, he will agree.

 

Thanks for checking up on me.

[csm2014]

Update:

 

Well, after a week of relative stability that took 10 days to get there, I started feeling worse again the last two days, especially yesterday (increased blood pressure, achey, fatigued, agitated/anxious) but felt much better at night. Can't understand why the setback.  Should I hold longer at this dose?

 

My concern has always been that I would eventually build tolerance to the Klonopin (the brakes I need while tapering the Lamictal). I sure hope it's not that. Have not heard back from my doc yet.

 

Thoughts?

[Rhiannon]

Update:

 

Well, after a week of relative stability that took 10 days to get there, I started feeling worse again the last two days, especially yesterday (increased blood pressure, achey, fatigued, agitated/anxious) but felt much better at night. Can't understand why the setback.  Should I hold longer at this dose?

 

My concern has always been that I would eventually build tolerance to the Klonopin (the brakes I need while tapering the Lamictal). I sure hope it's not that. Have not heard back from my doc yet.

 

Thoughts?

 

That's pretty normal, actually.  Don't be discouraged. These drugs cause a lot of changes in our brains, and our brains really don't have any mechanisms for how to fix that, so they wobble a lot as they recover. Just hang in there, I would say. Definitely don't start tapering again yet.

 

I am inclined to suspect that your diurnal variation (as described above) is due to cortisol levels, at least as much as it is due to medication reactions. Certainly the symptoms you describe are typical for me when I have bouts of high cortisol.  You might want to consider Alto's suggestions about timing of meds as well, but really right now is probably not a good time to be experimenting with changing things around, particularly since you have begun to stabilize (as evidenced by your recent bout of feeling better).

 

I really doubt it's a problem with the Klonopin. This kind of up-and-down pattern of symptoms is absolutely typical in your type of situation. The fact that you have had some improvement is a very good sign that you will be able to stabilize eventually. Once you've consistently felt pretty good and the roller coaster has mostly smoothed out (which will probably take another month at least) you should be able to restart your taper and do well.

[csm2014]

 

Update:

 

Well, after a week of relative stability that took 10 days to get there, I started feeling worse again the last two days, especially yesterday (increased blood pressure, achey, fatigued, agitated/anxious) but felt much better at night. Can't understand why the setback.  Should I hold longer at this dose?

 

My concern has always been that I would eventually build tolerance to the Klonopin (the brakes I need while tapering the Lamictal). I sure hope it's not that. Have not heard back from my doc yet.

 

Thoughts?

 

That's pretty normal, actually.  Don't be discouraged. These drugs cause a lot of changes in our brains, and our brains really don't have any mechanisms for how to fix that, so they wobble a lot as they recover. Just hang in there, I would say. Definitely don't start tapering again yet.

 

I am inclined to suspect that your diurnal variation (as described above) is due to cortisol levels, at least as much as it is due to medication reactions. Certainly the symptoms you describe are typical for me when I have bouts of high cortisol.  You might want to consider Alto's suggestions about timing of meds as well, but really right now is probably not a good time to be experimenting with changing things around, particularly since you have begun to stabilize (as evidenced by your recent bout of feeling better).

 

I really doubt it's a problem with the Klonopin. This kind of up-and-down pattern of symptoms is absolutely typical in your type of situation. The fact that you have had some improvement is a very good sign that you will be able to stabilize eventually. Once you've consistently felt pretty good and the roller coaster has mostly smoothed out (which will probably take another month at least) you should be able to restart your taper and do well.

The pharmacist and doc also do not think it's because the Klonopin is no longer working since I haven't been on it that long as many that experience tolerance have (like years). I will hopefully be in touch with my doc soon and will plough ahead & hold for now. I just hate this to drag out, but it is what it is. I am retesting my saliva cortisol levels again to see if any significant changes from the last test (which was pretty much normal).  I'm thinking I also swing from bouts of high and low cortisol and these psych meds, BP meds, and thyroid meds definitely affect it as well as other hormones. I long for the simple days not too long ago when I was on NOTHING and woke up feeling good and never had any of these issues. But there's no switch to go back and start over. I can only go from here. Thanks for the advice   

[Rhiannon]

I know, it's incredibly frustrating. My taper and withdrawal are fairly controlled but then throwing in the thyroid meds adds a whole new complication. Grrr! 

 

I'm not sure saliva cortisol levels are accurate. Don't know much about them but I think Alto has said they don't necessarily correlate with blood levels. I do know at the lab where I work we don't test saliva, only blood levels. I think your body can tell you as much as the tests can. I definitely agree--all these meds affect the neuroendocrine system in complex ways.

 

Hang in there. I think you'll stabilize to a more consistent level over the next weeks and months. That was a pretty fast taper, you're still recovering. One day at a time.

[csm2014]

I know, it's incredibly frustrating. My taper and withdrawal are fairly controlled but then throwing in the thyroid meds adds a whole new complication. Grrr! 

 

I'm not sure saliva cortisol levels are accurate. Don't know much about them but I think Alto has said they don't necessarily correlate with blood levels. I do know at the lab where I work we don't test saliva, only blood levels. I think your body can tell you as much as the tests can. I definitely agree--all these meds affect the neuroendocrine system in complex ways.

 

Hang in there. I think you'll stabilize to a more consistent level over the next weeks and months. That was a pretty fast taper, you're still recovering. One day at a time.

Thanks again. Saliva hormone testing for other hormones isn't always accurate from everything I've researched, but for cortisol, saliva has been the preferred method over serum. Personally, I do both serum and saliva. The problem with serum is that unless you draw all 4 times, you're only getting a snapshot of one reading.  This explains it better: http://www.stopthethyroidmadness.com/recommended-labwork/

[Pugknows]

 

Lamictal is an anti-seizure med like gabapentin, which is what I was told to CT by four drs. Your WD sxs are similar to mine. I destabilized from botched up and down taper in August. Jumped in November. Just now starting yo see some improvement. Still stuck with racing heartbeat, early morning cortisol surges, fatigue, breathlessness etc. Severity has lessened. (((Pug Hugs to you)) You'll be fine in time.

Thanks for the vote of confidence Pug. How long were you on Lamictal and at what dose (I didn't see your signature) and how did you finally taper? I can't believe these docs. In my case, I was only on it for 3 months and followed a taper which I find out now was too rapid. The taper wasn't too bad; it was jumping off the last dose when the w/d really kicked in. And after this one, I have the Klonopin taper to look forward to????.

 

Are you able to exercise? For me, it is my saving grace. Strength training & cardio. I also added a little yoga into the mix recently.

[Rhiannon]

 

I know, it's incredibly frustrating. My taper and withdrawal are fairly controlled but then throwing in the thyroid meds adds a whole new complication. Grrr! 

 

I'm not sure saliva cortisol levels are accurate. Don't know much about them but I think Alto has said they don't necessarily correlate with blood levels. I do know at the lab where I work we don't test saliva, only blood levels. I think your body can tell you as much as the tests can. I definitely agree--all these meds affect the neuroendocrine system in complex ways.

 

Hang in there. I think you'll stabilize to a more consistent level over the next weeks and months. That was a pretty fast taper, you're still recovering. One day at a time.

Thanks again. Saliva hormone testing for other hormones isn't always accurate from everything I've researched, but for cortisol, saliva has been the preferred method over serum. Personally, I do both serum and saliva. The problem with serum is that unless you draw all 4 times, you're only getting a snapshot of one reading.  This explains it better: http://www.stopthethyroidmadness.com/recommended-labwork/

 

 

Yep, serum testing is a nuisance. So in your experience the serum and saliva levels correlate pretty well? Good to know.

[Pugknows]

I didn't taper. I CT'd. My anxiety and cortisol surges are relentless during the day and decrease when it gets dark around 6pm. The cycle starts all over again at 3am with cortisol surging that wakes me up out of a dead sleep. I get no relief during the day and now my financial situation is forcing me to sell my house which is adding even more stress. Wish I could break the cycle. Not having a good day today. You will be fine very soon. Just give yourself the gift of time.

[csm2014]

 

 

I know, it's incredibly frustrating. My taper and withdrawal are fairly controlled but then throwing in the thyroid meds adds a whole new complication. Grrr! 

 

I'm not sure saliva cortisol levels are accurate. Don't know much about them but I think Alto has said they don't necessarily correlate with blood levels. I do know at the lab where I work we don't test saliva, only blood levels. I think your body can tell you as much as the tests can. I definitely agree--all these meds affect the neuroendocrine system in complex ways.

 

Hang in there. I think you'll stabilize to a more consistent level over the next weeks and months. That was a pretty fast taper, you're still recovering. One day at a time.

Thanks again. Saliva hormone testing for other hormones isn't always accurate from everything I've researched, but for cortisol, saliva has been the preferred method over serum. Personally, I do both serum and saliva. The problem with serum is that unless you draw all 4 times, you're only getting a snapshot of one reading.  This explains it better: http://www.stopthethyroidmadness.com/recommended-labwork/

 

 

Yep, serum testing is a nuisance. So in your experience the serum and saliva levels correlate pretty well? Good to know.

 

Actually, it is difficult to tell since they are done usually at different times and use completely different reference ranges.

[csm2014]

I didn't taper. I CT'd. My anxiety and cortisol surges are relentless during the day and decrease when it gets dark around 6pm. The cycle starts all over again at 3am with cortisol surging that wakes me up out of a dead sleep. I get no relief during the day and now my financial situation is forcing me to sell my house which is adding even more stress. Wish I could break the cycle. Not having a good day today. You will be fine very soon. Just give yourself the gift of time.

Sorry to hear you're still going through residual w/d from the Gabapentin. I've heard horror stories on w/ding from this med before. I also see that you were taking opiates for pain which are also addictive (I'm assuming something like oxy?). I guess the severerity of w/d depends on so many individual factors, one major one being the duration and dose of being on the drug. Thankfully, I was only on Lamictal for barely 3 mos. before tapering and @ 100mg which is a moderate dose. Still, what I've experienced tells me how sensitive I am, and with all my other past issues with cortisol, thyroid, parathyroid, kidney stones, hypertension, blood clots, allergies, and MTHR thrown into the mix , it gets very complex. I cannot tolerate alcohol and had bad panic attacks in my late teens and early 20s from experimenting with alcohol. I just don't do well with most meds or drugs. Thank God I knew to never get involved with recreational drugs growing up in the 70s and 80s as I'da been dead by now. 

 

Be lucky you don't have to come off a benzo which I face next once I get through this Lamictal w/d

[csm2014]

Update - last 10 days pretty much stabilized holding @ 25mg (still the early morning stuff, but ok throughout the rest of the day/night).  Saw my doc this last Wed. who thinks tapering further is still unnecessary (and I should just tough it out), but agreed to give me a scrip for some 5mg tablets (dissolvable) and started my re-taper the night before last @ 20mg (four 5mg tablets). Yesterday morning I started feeling even worse than the last setback 10 days ago (increased blood pressure, achey all over, fatigued, agitated/anxious) and then, as usual, started to feel better by night. Last night, I repeated the same dose, had trouble sleeping, agitated, frequent urination and still feel lousy this morning, but maybe not as bad as yesterday. 

 

I know everyone here recommends a 10% cut only at a time, however, I cannot understand that a cut of only 5mg would cause such an acute reaction and so quickly whereas before, I went from 100mg to 75mg to 50mg to 25mg with only moderate w/d that would take a few days to happen. Even the jump off the 25mg I didn't feel the effects of for several days. This makes me think it's a reaction to a different formulation of the same med, but the symptoms are dead ringers for w/d. Or, is it that since I acclimated to the 25mg (the lowest dose I re-stabilized on), I am more sensitive to smaller cuts now? I told my doc that if I get bad symptoms, to get me the 2mg tablets (or alternatively, I can just cut the 5mg in half which would equal 10%). I just hate dragging this taper out any longer than I have to, as I still have to taper off the other nasty psych med, Klonopin, and can't until I'm done with this one first!

  

 

Question now is: should I re-instate the 25mg as before to stabilize and then start tapering at a lower rate, stay the course and tough it out, or starting tonight, start tapering by cutting the 5mg pill in half and do 22.5mg?

 

 

 

    

 

    Thoughts?

[Fresh]

Hey csn , good to hear you were feeling more stable for 10 days.

 

Your cut of 5mg from 25mg is 20%.     As the doses get smaller , it seems to be more difficult to maintain stability with larger cuts.   I was reading a thread recently where a person who had tapered down to 7 beads from a capsule (where there are approx.240 beads)  got bad symptoms when he went down to 6 beads.

 

Although 5mg may not seem a lot to you , it does to your central nervous system.   You may want to revisit threads on how to taper , making your own liquid , using digital electronic scales.

 

Those are my thoughts   

[mammaP]

Hi CSM, the cut from 25 to 20 was 20%, if my sums are right, 10% is 2.5. (It just took me 5 minutes to work that out!  ) 

 

I would do as you said and either cut the tablet in half or take 4 and dissolve a whole tablet then throw away half the liquid to get the 22,5.

[mammaP]

I see Fresh got here before me and had the same figure which means I got it right for a change! 

[Fresh]

I would be trying to "nip it in the bud"  rather than "tough it out" , and probably try to stabilize on 24mg , and sit on that for 4-6 weeks , as recommended here.

[csm2014]

I appreciate the advice to taper with lower cuts, however, here is the catch-22 dilemma I face: I am told I cannot start tapering the Klonopin until already done with the Lamictal because it helps with acting as the "brakes" for glutamate receptor sensitivity when coming off the Lamictal. The longer it takes to taper off the Lamictal, the more time I accrue on the Klonopin (and thus dependency since it is a benzo) which when it comes to taper off it, I fear will be that much harder to taper. I just past the 4-month mark on Klonopin. I never thought the Lamictal would present these difficulties at the dose and duration I was on. My goal was to be already done with the Lamictal and be halfway through my Klonopin taper by now and not continue holding @ 0.5mg b.i.d.

 

Wish I would've never started either, but felt I didn't have a choice at the time.

 

Now, I feel forced and stuck on the Klonopin until I get off the Lamictal.

 

Thoughts?

[Rhiannon]

Well, the main thing that comes to mind is that it doesn't seem, from the people I've met over the years, that it's easier to taper off a benzo after four months than it is after a year. We develop dependency on those things pretty fast. 

 

I'd say, given your current condition, there's just not an easy choice for you. Fast isn't going to be tolerable, off either of the meds.

 

You can always alternate, taper the Lamictal down a little more, then work on the Klonopin for a while, so that you're bringing them both down together.  It won't be faster but you'll have the satisfaction of getting to lower doses on both.

 

The phenomenon of tougher tapering at lower doses is pretty much universal. Have you seen this:

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

If you're comfortable reading graphs, looking at those charts will give you a good idea of why it gets tough at lower doses. We don't have a chart for Lamictal, but so far it appears all the psych meds get tricky at lower doses, so I suspect they all show a curve similar to these.

[csm2014]

Well, the main thing that comes to mind is that it doesn't seem, from the people I've met over the years, that it's easier to taper off a benzo after four months than it is after a year. We develop dependency on those things pretty fast. 

 

I'd say, given your current condition, there's just not an easy choice for you. Fast isn't going to be tolerable, off either of the meds.

 

You can always alternate, taper the Lamictal down a little more, then work on the Klonopin for a while, so that you're bringing them both down together.  It won't be faster but you'll have the satisfaction of getting to lower doses on both.

 

The phenomenon of tougher tapering at lower doses is pretty much universal. Have you seen this:

http://survivingantidepressants.org/index.php?/topic/6036-why-taper-paper-demonstrates-importance-of-gradual-change-in-plasma-concentration/

 

If you're comfortable reading graphs, looking at those charts will give you a good idea of why it gets tough at lower doses. We don't have a chart for Lamictal, but so far it appears all the psych meds get tricky at lower doses, so I suspect they all show a curve similar to these.

 

Hmm, I was always under the impression that the severity of tapering symptoms was always relative to duration and dose.Guess I was wrong. If that's the case, then unless I was only on the Klonopin for a month or less, it really doesn't matter at this point? I would think dependency is hard to gauge since it's so unique to one's biochemistry.

 

Also, I do like the idea of alternating dual tapers as you've suggested, as it works toward the common goal of chipping away at the block over time. It definitely would ease my discomfort mentally, but don't know if it will be possible to handle physically without much discomfort that my beat up nervous system has already been through.

[csm2014]

I don't know if I'm over-analyzing this recent bout, but I wonder if the symptoms could be a reaction due to a change in the medication, as I went from a regular tablet to chewable/dispersable with different fillers, etc.. Last night, I seemed to feel worse after taking it. To test that out, it would be interesting to take 25mg (same as my prior dose) of the new tablets (five 5mg tablets) to see if I would still encounter these symptoms.

 

Alternately, I could go back to my old 25mg tablet I had previously stabilized on, crush it to a fine powder, then use my gram scale to measure out 22.5mg and let dissolve in water since it's impossible to dry cut that small of a pill to an exact weight.  The tablet actually weighs 75mg, so by taking 90% of that (90% of 25mg = 22.5mg), I would take 67-68mg. I noticed that it does not dissolve completely, so perhaps better to just dump the powder into my mouth first first, swish it around and then drink it? Ideally, I could have my compounding pharmacy custom make me any amount I want without fillers, but it would be too expensive. I have a ton of the 25mg tablets anyway. Man, this is getting really anal.

 

Thoughts?

[csm2014]

I recall reading a post on how sensitivity to w/d increases as we approach the end of a taper (if someone could please re-post the link to this, I'd greatly appreciate).  So I challenged the theory and did some bold experimentation this last week to discover this firsthand and that I am likely no exception.

 

Since my reinstatement I posted upthread, I had cut from 25mg to 14mg in 60 days. My first cut was 10 days @ 22.5mg. From then on, I would cut every 7 days (the next @ 20mg). Since I was relatively stable with these first 2 cuts, I got a bit over-confident from these last 2 cuts (17mg, then 14mg), already breaking the 10% rule. As I was still doing pretty well (except for the early mornings which were transient), I increased my cut even more starting this last week, down to 10mg from 14mg (over 28%). Come the 5th day of the cut, like clockwork, I started feeling worse, with all the same atypical symptoms as prior (waking early and not being able to fall back asleep, agitated, anxious, depressed, moody, achey, loss of appetite).

 

So last night, I decided to updose to 12mg. Although I still felt lousy in the early a.m. today as is typical for me, I gradually felt better by noon and the rest of the day/night, with a marked decrease in overall symptoms vs. yesterday. Again, it amazes me that even 2 lousy milligrams has this effect of my nervous system. Thus, it is so hard to determine whether the way I feel is truly withdrawal and not a myriad of other things when I'm in the moment - and that just makes the suffering worse. How do we really know? They say Lamictal typically doesn't have withdrawal syndrome like benzos. But others have reported it can be just as intense or sometimes worse. 

 

It seems that these cuts take forever, but are so integral to tempering withdrawal. I have to let go of the battle against the clock ticking away and my impatience to start my taper off the Klonopin, but it is hard. I have decided NOT to try and taper more than one med at a time.

[Fresh]

Hi csm ,   is the link you want the one on post 68 of this thread?

 

It's all a bit of trial and error , and others have encountered problems when they change brands like you did.

 

Sounds like you're feeling it out for yourself , so well done.

 

Fresh