childishbranzino: Lamictal and Abilify

[childishbranzino]

Hi. Typing is really hard so I’m gonna keep this relatively short. I’ve been on more than a dozen different medications over the past three or so years. Never had any withdrawal type problems tho until I came off Lamictal (taken from April-June 2018, max dose 100mg, two week taper which I know now wasn’t enough but doctorsssss). Withdrawal came with severe confusion, memory problems, headaches, depression, etc. 

 

Symptoms persisted through the end of the year so psychiatrist prescribed 2mg abilify. I took it for three nights and stopped bc I started getting muscle spasms. Noticed over the next couple weeks that my cognitive function had declined even further and that’s kinda where I am now. Things are worse than they’ve ever been before and I’m not really sure what to do about it. I’ve already had to medically withdraw from school pre-abilify and now things are a lot worse. I’m enrolled in a day treatment program (basically a handful of loosely connected support groups) and cognitive remediation treatment (which I’ve read mixed things about) but otherwise I have nothing going on and I feel like I’m losing my mind? From what I understand it could be years before I regain anything like my baseline function. I’ve lost my train of thought. I just want my life back. 

[ChessieCat]

Hi childishbranzino and welcome to SA,

 

To get you started please create your drug signature using the following format.   Keep it simple.  NO diagnoses or symptoms please - thank you.

• details for last 2 years - dates, ALL drugs, doses
• summary for older than 2 years - just years and drug/s

Account Settings – Create or Edit a signature

 

Once we have more details about your drug history we will be better able to offer suggestions.

 

This is your own introductions topic where your can ask questions about your own situation and journal your progress.

[Altostrata]

Welcome, childish.

 

It sounds like you have lamotrigine withdrawal syndrome from coming off lamotrigine too fast in June (?), plus an adverse reaction to Abilify.

 

When people go on and off psychiatric drugs, their nervous systems may become hypersensitive to drugs and even supplements and foods.

 

If I were you, I'd get a prescription for compounded liquid lamotrigine and try 0.5mg to start, to see if reinstatement can help. It's important to start very low in case your nervous system is sensitized; a small amount is less likely to cause a big adverse reaction. Please let us know how you're doing.

 

If you can't get a compounded liquid, this topic explains how to make your own Tips for tapering off Lamictal (lamotrigine)

 

If it helps, you'd stay on a low-dose reinstatement for some months, then taper off by tiny amounts later.

 

Your drug history in your signature would be helpful in further discussion.

[ChessieCat]

25 minutes ago, Altostrata said:

If I were you, I'd get a prescription for compounded liquid lamotrigine and try 0.5mg to start, to see if reinstatement can help. It's important to start very low in case your nervous system is sensitized; a small amount is less likely to cause a big adverse reaction. Please let us know how you're doing.

 

About reinstating and stabilizing to reduce withdrawal symptoms

[childishbranzino]

Updated w signature

[childishbranzino]

Are there any good psychiatrists in NYC who could help me w reinstatement? 

[Altostrata]

Thank you for your drug history.

 

With your complex drug history of many drug changes, it could be that many of your symptoms have been either withdrawal syndrome from earlier drugs or adverse effects from drugs and drug combinations.

 

What your doctors have been treating might well have been a sensitized and unstable nervous system for years.

 

It's impossible now to unravel this. However, a very low dose of lamotrigine might help your nervous system stabilize.

 

I assume -- correct me if I'm wrong -- that you tried up to 100mg lamotrigine last spring and never had any benefit from it. That may be because you were taking too much lamotrigine, which can cause side effects, particularly in sensitized nervous systems. See

 

One theory of antidepressant withdrawal syndrome

 

Lamictal (lamotrigine) to calm post-discontinuation withdrawal symptoms

 

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

 

Because so many people here have hypersensitive nervous systems, we suggest tiny dosages at which most physicians would scoff. However, we see that a little goes a long way when a person's nervous system has been battered by psychiatric drugs. We are also all about trying a very small change and observing for at least a week to see what happens.

 

If you try 0.5mg lamotrigine, you may at first feel nothing. You may wish to give it a week, then increase by perhaps 0.5mg, observe again.  If you get a very slight calming effect, this is a good sign. Stabilization will be very gradual, taking place over months. You will need to be patient.

 

In requesting a compounded prescription lamotrigine liquid, you might tell your doctor you wish to ramp up slowly. Any doctor can prescribe this, it doesn't have to be a psychiatrist. We don't know of any doctors in NYC who know anything about low-dose reinstatement. You'll have to phone around and see who will work with you.

 

Please let us know how you're doing.

[childishbranzino]

Thank you!

 

re lamotrigine, that’s correct. The 100mg dose provided no benefit and came with severe side effects. 

 

Re compounded liquid, two questions 

by ramp up slowly do you mean slowly ramping up to 0.5mg and then continuing with that dose? 

And do you think I should ask the doctor for that specifically? 

[Altostrata]

You can start at lower than 0.5mg if you feel more confident with that.

 

Lamotrigine would seem to be a good place for you to start because 1) you may be suffering withdrawal symptoms from lamotrigine; 2) overall, it can be used to stabilize a nervous system sensitized by going on and off psychiatric drugs.

 

(By the way, how's your sleep?)

 

Your doctor will not understand that you might want to take only 0.5mg lamotrigine (or less). The normal starting dose is 25mg. If you explain you want the liquid to ramp up to a low dose before trying 25mg, your doctor will be more inclined to help, as they generally love to get people on psychiatric drugs and stop the complaining.

 

It is unlikely you will find a doctor who grasps that your nervous system has been sensitized and destabilized by drugs. While this may be intuitively obvious to anyone who has experienced an adverse reaction to a psychiatric drug, it is an article of faith among physicians that they cause no enduring damage.

 

Therefore, it's best to keep your plans general and simply ask for a compounded liquid prescription in order to ramp up from a dose lower than 25mg.

 

General practitioners tend to be more sympathetic to this type of request. They don't have time to deal with "mental health" issues and would just as soon you take a drug and not bother them. Some of them have seen withdrawal syndrome and are more understanding about it. Psychiatrists tend to be in denial.

 

Probing the medical profession will be an interesting project for you. Don't get discouraged; in all of NYC, there's bound to a physician who would help. As a last resort,  you can make your own liquid, see Tips for tapering off Lamictal (lamotrigine)

[childishbranzino]

Yeah that makes sense. I found a GP a while ago that I’ve been meaning to get in contact tact with. I’ll call her this week. 

 

Sleep is not good. Lately I’ve been getting either too little (4-5 hours) or too much (~10 hours). I feel exhausted all the time. 

[Altostrata]

Please be sure to keep regular hours and get off the computer by 8 p.m. It's important to nurture your sleep cycle.

[ChessieCat]

10 hours ago, Altostrata said:

in order to ramp up from a dose lower than 25mg

 

In other words, to increase slowly.

 

You might find it helpful to write a script and rehearse what you are going to say.  Be calm, gentle but assertive.  You are the customer, it is your body.  Use words like I'd like to try this.  If a suggestion is made that you don't want to follow, say I'd like to think about it before making a decision.

 

How do you talk to a doctor about tapering and withdrawal?

What should I expect from my doctor about withdrawal symptoms?

[childishbranzino]

“To qualify as antidepressant discontinuation syndrome, the symptoms should not have been present before the antidepressant dosage was reduced”

 

That’s not quite how it was. I was experiencing significant cognitive decline and headaches and such while taking the Lamictal. That’s why I discontinued it in the first place. Does that change anything? 

[Altostrata]

As I explained before, the Lamictal dosage you were taking before was too high and caused side effects.

 

1 hour ago, childishbranzino said:

significant cognitive decline and headaches and such

 

^These are adverse effects from taking TOO MUCH Lamictal.

 

Even though you were taking too much Lamictal before, you may still have withdrawal symptoms from going off it too fast. Doesn't seem fair, but that's how it is.

 

You can have BOTH adverse effects while taking Lamictal AND withdrawal symptoms from going off it.

 

Taken in the appropriate LOW DOSE, Lamictal can be helpful in stabilizing a nervous system that's been upset by going on and off random psychiatric drugs for several years.

[childishbranzino]

Gotcha. Thanks!

[childishbranzino]

Ok I’m still working on finding a doctor who can help me reinstate (I think I’ve figured out the right approach) but my symptoms are getting worse. It’s becoming very difficult to have normal conversations with people. My memory problems keep getting in the way. I keep missing what people are saying. Stuff like that. Anyway I guess I’m wondering what can I even expect out of reinstatement at this point? It’s been about seven months since I’ve been fully off the Lamictal and I know it’s less likely to be effective the more time passes. Are there any concerns I should have? Do I need to account for the Abilify in some way? Idk I feel like I’m flying totally blind. 

[ChessieCat]

On 1/22/2019 at 7:12 AM, Altostrata said:

 

Taken in the appropriate LOW DOSE, Lamictal can be helpful in stabilizing a nervous system that's been upset by going on and off random psychiatric drugs for several years.

 

 

This topic discusses doses:  lamictal-lamotrigine-to-calm-post-discontinuation-withdrawal-symptoms

 

Edited February 5, 2019 by ChessieCat

[Altostrata]

We can't predict what a little lamotrigine, or any reinstatement, will do. All you can do is test a very low dose and see what happens.

[childishbranzino]

Took a while but I finally started reinstating. I got a prescription for 5mg tablets of Lamictal (the lowest dose my psychiatrist was willing/able to prescribe) and am using those to make a liquid suspension. So far I’ve taken two 0.5mg doses (one tonight and one the previous night) and I’m not sure how to describe how I’m reacting. I’m feeling kind of lightheaded and maybe a bit more anxious? It’s hard to tell tho, especially because my condition has been steadily getting worse this whole time. Anyway how will I know if/when I need to increase the dose? Or like, if it doesn’t help how can I tell if it’s because I’m not at the right dosage or if it’s because reinstatement just won’t work at all at this point? 

 

Thank you for all the advice so far

[ChessieCat]

Please keep daily symptom notes on paper and post them here in your Introduction topic so they can be assessed.

 

Example:

 

6 a.m. Woke with anxiety
8 a.m. Took 2.5mg Lexapro
10 a.m. Stomach is upset
10:30 a.m. Ate breakfast
11:35 a.m. Got a headache, lasted one hour
12:35 p.m. Ate lunch
4 p.m. Feel a bit better
5 p.m. Took 2.5mg Lexapro
6 p.m. Ate dinner
9:20 p.m. Headache
10:00 p.m. Took 50mg Seroquel
10:20 p.m. Feeling dizzy
10:30 p.m. Fell asleep
2:30 a.m. Woke, took 3mg Ambien (NOT "took 1/2 tablet Ambien")
2:45 a.m. Fell asleep
4:30 a.m. Woke but got back to sleep

[childishbranzino]

Don’t have a notebook so I’ve been keeping notes on my phone. Here’s what I have so far:

 

3/9/19

 

10:30 woke up feeling dizzy/spacey

11:30 ate breakfast 

12:00 still feeling dizzy/spacey, brief periods of heightened anxiety

2:15 more anxiety, increased heart rate, muscle tension 

3:00 anxiety leveled off, still feeling lightheaded

Consistent brain fog doesn’t go away 

4:15 brain fog is worse, fatigue

4:45 headache 

5:00 ate dinner

7:45 anxiety again

10:00 took 0.5mg lamictal 

11:40 warm, fuzzy feeling in head (not as pronounced as previous nights)

 

3/10/19

 

11:30 woke up feeling confused 

12:30 ate brunch

3:30 confusion worse, no anxious feelings (ie heart rate, tightness, etc) though

Sense of taste is weird, everything tastes less

 

Edited March 10, 2019 by ChessieCat
resized

[childishbranzino]

3/10/19

 

11:30 woke up feeling confused 

12:30 ate brunch

3:30 confusion worse, no anxious feelings (ie heart rate, tightness, etc) though

Sense of taste is weird, everything tastes less

4:45 nausea 

10:20 confusion, fuzzy feeling 

11:40 took 0.5mg lamictal 

1:00 took 300 microgram melatonin supplement 

 

3/11/19

9:30 woke up with headache and confusion

10:00 ate breakfast

11:00 headache intensifies

11:30 nausea

8:30 headache, buzzing feeling

10:00 empty, manic feeling

11:00 took 0.5mg Lamictal

[Altostrata]

How are you sleeping?

 

Are the headaches and nausea new symptoms? When did they start?

 

[childishbranzino]

I’m sleeping alright bc of the melatonin supplements (it’s hard to fall asleep without them). Headaches and nausea aren’t really new. I think they started a couple weeks ago. But last night after I posted my update I started feeling really intense confusion,  anxiety and dysphoria. I felt like my body and my voice weren’t mine. Or like I was a different person. I asked my girlfriend if she was noticing anything different and she said I didn’t seem like the same person. I still feel that way now. 

[childishbranzino]

That’s a new feeling, to be clear. 

[childishbranzino]

All of this is extremely distressing

[childishbranzino]

3/12/19

10:30 woke up anxious, dysphoric, confused

1:20 headache, severe confusion 

9:00 ate dinner

11:00 intense confusion, anxiety, depression 

12:00 took 0.5mg lamictal

 

3/13

Feel really slow all day, like a different person

11:10 took 0.5mg Lamictal, 3 mcg melatonin 

 

3/14

8:00 woke up feeling concussed 

12:00 still feel concussed, memory and thinking dramatically impaired

[childishbranzino]

Is it normal to react this way during a reinstatement? Should I push through these symptoms or should I start tapering off? I don’t really know what to do. 

[Altostrata]

On 3/8/2019 at 8:56 PM, childishbranzino said:

Took a while but I finally started reinstating. I got a prescription for 5mg tablets of Lamictal (the lowest dose my psychiatrist was willing/able to prescribe) and am using those to make a liquid suspension. So far I’ve taken two 0.5mg doses (one tonight and one the previous night) and I’m not sure how to describe how I’m reacting. I’m feeling kind of lightheaded and maybe a bit more anxious? It’s hard to tell tho, especially because my condition has been steadily getting worse this whole time. Anyway how will I know if/when I need to increase the dose? Or like, if it doesn’t help how can I tell if it’s because I’m not at the right dosage or if it’s because reinstatement just won’t work at all at this point? 

 

Thank you for all the advice so far

 

You've been on the 0.5mg lamotrigine for a week. How has your symptom pattern changed?

 

If the headache and nausea started a couple of weeks ago, they're not side effects of lamotrigine. However, you had a bad reaction to lamotrigine before, correct? Are any of your present symptoms like those adverse reactions?

[childishbranzino]

It’s just made me feel that much slower. Which is what happened when I took it to begin with last year. It’s just happened so much faster. 

[childishbranzino]

I’ve been performing a lot worse on most of my cognitive remediation drills since I started reinstating too 

[childishbranzino]

I basically feel like a different person 

[childishbranzino]

3/15-17 

Took 0.5mg lamictal and 300 mcg melatonin every night, felt concussed all day

 

3/18

9:30 woke up feeling concussed and dizzy

[childishbranzino]

Should I start tapering off? 

[childishbranzino]

I really need help 

[Altostrata]

How are you taking 0.5mg lamotrigine, as a liquid? I would reduce it to 0.25mg, keep daily notes.