Emma7855: request for help with Lamictal withdrawal symptoms

[Emma7855]

I'm a complete and utter idiot. Because of my stupidity I've caused myself to further go into withdrawal. Not sure where to go from here. 

To summarize:

- December 2019: Decided to try 4mg Trileptal at doctor's suggestion. It didn't do anything. Still on it. 

- January 2020: Tried going back on birth control. Took one pill and got brain fog; it also "aged" me. Immediately stopped.

- March 2020: Had a microneedling procedure done on my face to fix the "aging. " It backfired and caused extreme inflammation and scarring. Developed burning on my cheeks because of it, a histamine reaction, and hives.

- April - June 2020: Used a curcumin gel on my face daily to reduce the inflammation. Also used Elidel cream (immunosuppressant) and 1% hydrocortisone cream on my cheeks as needed to help with the burning. Throughout this time I developed odd endocrine symptoms (which I described in another post), thin skin, dry skin, cold extremities, anxiety, insomnia, and more brain fog. I couldn't figure out if they were related to withdrawal or low estrogen caused by the curcumin gel (which is a phytoestrogen). Finally tapered off the curcumin gel, but each time I decreased the dose I got more endocrine symptoms. 

- July 2020: Used a vitamin E cream once. Developed extreme brain fog and worsened dissociation. 

 

So here's where I currently stand:

- I'm still taking 35 mg Lamictal in addition to 4 mg Trileptal. I have a host of withdrawal symptoms. 

- I have burning on my cheeks and scarring on my face from a botched microneedling procedure. Developed a histamine reaction and hives as a result, and I'm intolerant to putting any moisturizers on my face. I need to either use a collagen cream or have LED treatments to fix it, but I'm scared these will aggravate the withdrawal.

- I developed perimenopausal symptoms from using the curcumin. I need to possibly use hormone replacement therapy to fix my symptoms, but again I'm concerned it'll aggravate the withdrawal.

 

Throughout this period I saw about 10 doctors, none of whom knew how to help. 

 

Not sure where to go from here. Any help would be greatly appreciated. 

[Emma7855]

Would anyone be able to help me? The brain fog and dissociation are significantly worse. Should I go back on the curcumin? I have daily notes of symptoms from the past few months if that would be helpful. Thanks.

[Frogie]

2 hours ago, Emma7855 said:

Would anyone be able to help me? The brain fog and dissociation are significantly worse. Should I go back on the curcumin? I have daily notes of symptoms from the past few months if that would be helpful. Thanks.

If you could, post a couple days of daily notes so a mod can help you. I’m sorry you are going through this I hope you feel better soon.

 

Take care,

 Frogie xx

[Emma7855]

Thanks so much, @Frogie! That's very nice of you. Hope you're doing well. 

[Frogie]

4 minutes ago, Emma7855 said:

Thanks so much, @Frogie! That's very nice of you. Hope you're doing well. 

You are more than welcome. 😊

[Emma7855]

I developed anxiety, suicidal ideation, insomnia, heart racing, dry skin, muscle aches, and hives after layering 1% hydrocortisone cream over Psoria-Gold curcumin gel in mid-April. Symptoms got worse after layering Elidel over Psoria-Gold curcumin gel in early June. I believe my hormones became affected as well; they are now on the very low end of normal and I am experiencing symptoms of perimenopause at 31 years old. My levels of vitamin D and B12 are also low. I tried taking a microdose of a vitamin D supplement but it exacerbated my withdrawal symptoms. In retrospect when I went off of birth control pills last March I developed post-birth control syndrome (brain fog, mood swings, appetite loss, etc), but I had no idea at the time what was going on. The symptoms now are severely worse. Apparently the cure is to go back on birth control pills or do HRT, but I'm too sensitive for either. I have no idea if the hormone-related symptoms will ever go away on their own, or if there's anything I can do to improve them. 

 

Here are notes on symptoms from the past month. "Moisture Seal" is the "light" curcumin gel (1%) and "Face Ultra" is the "heavy" curcumin gel (20%). At night I also take 35 mg Lamictal and 4 mg Trileptal (not included in the notes).

 

Thanks in advance for the help.

 

Date	AM	PM	Symptoms
6/4/20	Face Ultra	Face Ultra // Elidel	Woke up at 6, then again at 9:30 with heart racing. Hives.
6/5/20	Face Ultra // Elidel	Face Ultra // Elidel	Burning a few hours after using Elidel. Hair loss getting worse at hairline, temples, and top of head.
6/6/20	Face Ultra // Elidel	Face Ultra // Elidel	Woke up after 5 hours but then went back to sleep. Woke up again with heart racing. Can't focus while reading. Brain fog after working out? Face uncomfortable after working out. Ear ringing all afternoon. Face and ears burning in evening. Dry skin.
6/7/20	Face Ultra // Elidel	Face Ultra // Fish oil	Got 7 hours of sleep. Woke up with heart racing. Noticed white flakes on hands, feet. Bumps on chest. Very dry skin. Hair part is wider.
6/8/20	Nothing	Face Ultra at ~3PM (washed off shortly afterwards) // Fish oil	Got 5 hours of sleep. Heart not pounding as much. Slight brain fog after fish oil. Cried most of the day. Cold hands and feet. Sensitive to temperature. Loss of appetite. Hives.
6/9/20	Nothing	Face Ultra (smidge; washed off shortly afterwards)	Fell asleep at 3AM, woke up at 6AM with heart racing. Feel terrible emotionally. Back hurts. Sensitive to temperature. Receding hairline worse than on the 6th. Loss of appetite.
6/10/20	Face Ultra	Face Ultra (washed off a few hours later)	Got 6 hours of sleep. No anxiety when waking up. Extreme depression throughout day. Despondent.
6/11/20	Nothing	Face Ultra (washed off a few hours later)	Wake up throughout night with heart racing. Can't focus.
6/12/20	Nothing	Moisture Seal	Got 6 hours of sleep. Wake up with heart racing. Lights have more lines eminating from them.
6/13/20	Nothing	Face Ultra (washed off a few hours later) // Moisturizer	Slept well. Small amount of anxiety. Hives.
6/14/20	Nothing	Face Ultra (washed off a few hours later)	Went to bed at 11:30, woke up at 4, fell asleep at 5:30, then woke up at 8:30. Heart racing throughout day. Hands look more wrinkly.
6/15/20	Nothing	Moisture Seal	Went to bed at 11:30, briefly woke up at 4, woke up at 8? Heart racing.
6/16/20	Nothing	Moisture Seal	Went to bed at 1, woke up at 7:30, went back to bed and woke up at 9. Strong brain fog. Heart not racing as much. Losing eyebrow hair. Wrinkles worse. Cheeks burning after lunch. Skin feels dry.
6/17/20	Nothing	Moisture Seal	Woke up in middle of night with no anxiety. Woke up in morning with anxiety. Strong brain fog. Back hurts. Hives.
6/18/20	Nothing	Moisture Seal	Got 6 hours of sleep. Woke up with minor anxiety. Strong brain fog. Back hurts.
6/19/20	Nothing	Moisture Seal // Used various moisturizers, but they all burned, so I washed them off shortly afterwards	Got 6 hours of sleep. Moved to couch and slept for a bit there. Strong brain fog. Back hurts.
6/20/20	Nothing	Moisture Seal // Moisturizer. Washed everything off 30 min later because of burning Reapplied Moisture Seal.	Woke up after 3 hours. Went back to bed on couch. Neck skin feels looser.
6/21/20	Moisture Seal	Moisture Seal	Woke up throughout night. Neck skin feels looser. Decent mood in afternoon.
6/22/20	Moisture Seal	Moisture Seal	Woke up after 3 hours and then after 4 hours. Bed slightly more comfortable? Heart slightly racing after waking up in morning. Brain fog when waking up.
6/23/20	Moisture Seal	Moisture Seal	Woke up after 5 hours. Fell asleep for another hour; woke up with heart beating faster. Crying in afternoon. Hives.
6/24/20	Moisture Seal	Moisture Seal	Woke up in middle of night. In morning, woke up with heart racing and extreme depression. Face dry. Crying.
6/25/20	Moisture Seal	Moisture Seal	Woke up in the middle of the night. In the morning, woke up with heart racing and extreme depression. Dry skin. Jeans stick to legs. Crying.
6/26/20	Moisture Seal	Moisture Seal	Woke up in the middle of the night. In the morning, heart racing. Sad. Feet are dry. Noticed hair growing in white.
6/27/20	Moisture Seal	Moisture Seal // Vitamin E suppository	Woke up after 7 hours. Went back to bed and woke up with anxiety.
6/28/20	Moisture Seal	Moisture Seal // Vitamin E suppository (x3)	Hard time falling asleep. Slept 2-6 AM. Hives.
6/29/20	Moisture Seal (late in day)	Moisture Seal	Hard time falling asleep. Woke up throughout night with heart racing. Crying in morning. Sad all day. Extreme brain fog, strong tinnitus, and worse depersonalization in afternoon (shortly after using Moisture Seal).
6/30/20	Moisture Seal	Moisture Seal	Hard time falling asleep. Woke up throughout night with hot flashes. Woke up in morning with strong brain fog. Hard time focusing. Improved over course of day. Neck skin feels looser. Worse depersonalization. Hives.
7/1/20	Moisture Seal	Moisture Seal	Woke up at 1 and 4:30. Woke up in morning with strong brain fog and tinnitus. Worse depersonalization.
7/2/20	Moisture Seal	Moisture Seal // Mineral oil suppository	Couldn't fall asleep until 12. Slept for 7 hours. Eyebrows thinner. Brain fog after suppository? Can't concentrate/think in evening. Worse depersonalization.
7/3/20	Moisture Seal at 1 PM; washed off at 1:30 PM	Nothing	Couldn't fall asleep until 1. Woke up in middle of night. Woke up with strong brain fog. Worse depersonalization.. No anxiety.
7/4/20	Nothing	Nothing	Slept okay. Strong brain fog, tinnitus, and depersonalization.
7/5/20	Nothing	Applied various moisturizers; burned so washed them all off	Slept okay. Strong brain fog, tinnitus, and depersonalization. Hives.
7/6/20	Nothing	Nothing	Couldn't fall asleep until 2. Woke up at 10 with strong brain fog and tinnitus. Strong brain fog throughout day. Slept okay. Strong brain fog, tinnitus, and depersonalization.
7/7/20	Nothing	Nothing	Woke up in middle of night. Got 6 hours of sleep; woke up with minor anxiety. Brain fog not as strong as yesterday. Eyebrows thinner. Appetite smaller. Breasts larger. Worse depersonalization.
7/8/20	Nothing	Nothing	Woke up in middle of night and then early. Strong brain fog. Appetite smaller. Worse depersonalization.
7/9/20	Nothing	Nothing	Eyebrows thinner. Worse depersonalization. Hives.
7/10/20	Nothing	Nothing	Didn't fall asleep until 3 and woke up at 7:30.

[Altostrata]

We do not counsel about steroid withdrawal issues here. See an endocrinologist, or join a steroid forum site.

 

A thought: Maybe you should stop playing around with steroids?

[Emma7855]

Hi @Altostrata and/or someone else -- On the 1st and 2nd I couldn't take my dose of Lamictal because I was waiting for my psychiatrist to refill my prescription. I started taking it again on the 3rd, but since then I've had more brain fog and dissociation. Do I need to take a lower dose now? Or should I keep taking the same amount? Thanks.

[Altostrata]

I would keep taking the same amount. Do what you can to assure you have a steady supply. A psychiatrist doesn't have to prescribed these drugs, your GP could do it. Do you need to keep the psychiatrist on your payroll?

[Emma7855]

Thanks @Altostrata. Yes good point. I do pay her an obscene amount for her just tell me she doesn't know what's going on and that I should stop taking everything (needless to say, I haven't listened to her).

[Emma7855]

Hi -- I'm losing a significant amount of hair all over my body. I've seen countless doctors, who have said the only treatments are Rogaine (for head hair) and Latisse (for eyebrows/eyelashes). Does anyone here have experience with those? I tried searching but didn't come up with much. Thanks.

[Emma7855]

@Altostrata, if I'm sensitive to vitamin D (I react to any vitamin D supplement), would taking cod liver oil be a good solution (like this one, https://www.rositausa.com/products/extra-virgin-cod-liver-oil-liquid?variant=33305954713644 )? The oil has vitamins A and D that are naturally occurring, so I assume this would be equivalent to eating fatty fish (which I don't react to). I'm severely deficient in vitamin D and need to figure out a way to raise my levels without taking artificial supplements. Thanks. 

 

Edit: Added some more info.

[Altostrata]

Sorry, cannot advise you about hair loss. I would not add anything in pill form or that can go systemic.

 

If you need D3, you may be able to get very low dose liquid vitamin D3, take a tiny drop to start and build up over time.

[ChessieCat]

6 hours ago, Emma7855 said:

I'm severely deficient in vitamin D and need to figure out a way to raise my levels without taking artificial supplements.

 

The easiest and most natural way is to spend time outside in the sunlight, obviously when the uv rays are least harmful.  Do an internet search for vitamin d sunlight

[Emma7855]

Thanks, @Altostrata and @ChessieCat. Unfortunately I tried taking a liquid vitamin D3 supplement, and even one drop revved me up. I'll try the natural sunlight approach, but I live in the PNW so that might be a little challenging.

[Gridley]

@Emma7855

 

Emma, 

 

You might consider food sources of vitamin D.  Here are some foods high in D.     

 

Good sources of vitamin D

• oily fish – such as salmon, sardines, herring and mackerel.
• red meat.
• liver.
• egg yolks.
• fortified foods – such as some fat spreads and breakfast cereals.

 

 

[Emma7855]

Thanks, @Gridley! I just bought some sardines; I'll try eating a serving size per day. 

[Altostrata]

You may want to wait for 6 months or so, let your hypersensitivity calm down, before trying vitamin D3 supplementation again.

[Emma7855]

Good point, thanks @Altostrata. Is 6 months the average time that it takes for a hypersensitivity to dissipate?

[Emma7855]

Update: I decided to have an acupuncture treatment on Monday to help "nudge" my hormones in the right direction (my naturopath, who specializes in endocrinology, told me that acupuncture would be gentler than medication). Also, looking at the acupuncture thread here, I saw that some people benefited from it, so I figured it was worth a shot.

 

Well, I was wrong. The treatment unfortunately put me in another wave, and now I have the following additional symptoms: stronger suicidal ideation, stronger brain fog, stronger tinnitus, shortness of breath, difficulty breathing, heart racing, hot flushes, more acne, and more wrinkles/aging. 

 

Literally everything I've tried has made me worse. I can't win. I give up.

[Icip]

@Emma7855,

 

I’m sorry Emma, sometimes you can feel stuck - whether that’s stuck feeling like you do, or like you’re all out of options. There’s not much we can do other than to wait, and trust our bodies. I myself find finding things to pass the time, or to help ‘take the edge off of things’ quite hard.

 

How are you feeling about everything, how hopeful are you? I’ve messed up a lot during my journey, I’ve made a load of mistakes, I’ve had setbacks that weren’t of my own design (this has been mostly the case). The symptoms that you’ve gained won’t stay with you forever, they’ll go soon as you’ve just prodded your central nervous system a little too hard.

 

Time, stability, peace, friendship, and happiness, have all been my biggest benefactors, and are what have gotten me this far - I think they’re the pillars of a good life itself, nothing external, or too forceful. Try not to worry, everything seems to worry us, about being stuck like this - but it won’t be forever, what’s happening to us is out of our control, so we just need to sit back and make sure that our brains have as smooth a ride as possible getting back to where they need to be.

 

I hope you’re okay,

 

Icip.

[Emma7855]

Thank you for the kind words, @Icip. I appreciate your stopping by and comforting me. I, too, have made a number of mistakes, and I'm so mad at myself because I should have known better. My anxiety got the best of me, and I got carried away in treating other ailments that ended up further affecting my withdrawal. Unfortunately, these treatments inadvertently affected my hormones as well, and now I don't think they will ever reset, even after the withdrawal subsides. If I had just stopped last year when Altostrata first diagnosed me with withdrawal, I wouldn't have the hormone problems, and I'd be so much further along in my recovery. I'm so, so angry at myself. I'm working to forgive myself but it's really hard.

 

Thanks for reminding me that I'm not alone, that we all make mistakes, and that healing is possible. I hope you're doing well yourself. ❤️ 

[Icip]

@Emma7855,

 

Nothing is irreversible, withdrawal/adverse reactions i think affect all of our hormones a fair bit. I've had horrible dry skin on my hands, that peels after each time (more or less) i wash my bowls and cutlery. I didn't think i had so many layers of skin.

Healing is always possible, i've come far, though whilst not there, i still need to remind myself of that every day. There'll be a day for all of us, we jsut need to get there first:)

 

I'm doing okay thank you:) though obviously not amazingly,

 

Icip.

[Icip]

Also, you mentioned that the birth control pill aged you. The skin on my face also took a hit after i had an adverse reaction to my medication - this is slowly getting better, along with the skin on my hands. I managed to go two weeks without it peeling, only just started peeling today - but i suspect that it's moreso down to the harsh temperature changes we're having here in the UK.

[Guest]

@Emma7855

 

are acne and aging lines something youve experienced in withdrawal for a long period of time? I also have had it for years 

[Emma7855]

Thanks, @Icip. I (theoretically) know that we're supposed to heal from the withdrawal, but I don't know if that includes the hormonal changes. Did the rest of your skin take a hit too or just your face/hands? Have you done anything to try helping it, like taking supplements?

[Emma7855]

@Ryguy, no I just got the aging/acne after I inadvertently starting messing with my hormones (I was already in withdrawal at this point). Then I tried various things to reset them, and that only made my situation worse. Now I look around 10 years older than I actually am, complete with white hair and severe wrinkles. It's terrible. What about you? Have you done anything to try to solve it? What are your other symptoms? Have you gotten any windows, or have you just been in one long wave? 

[Emma7855]

Hi all -- Does anyone here know how we're supposed to treat ailments (like in my case, a severe hormone imbalance) if we're sensitive to everything? Or does the hormone imbalance solve itself after withdrawal ends?

 

And as a follow-up question, can we only heal from the withdrawal if we're off of all brain-altering medications (in my case, Lamictal/Trileptal)? I'm not sure if I should continue holding at the current dosages forever, or if I should attempt to get off of everything. I don't have any side effects from either one (at least, not that I can tell), possibly because the dosages are too low. So at this point I just want to ensure I'm setting my brain up for success to heal from withdrawal. Thanks.

[Icip]

@Emma7855,

 

Re my skin, it 'seemed' to jsut be my hands and face, maybe the rest of my skin - but they arent dubjected to the normal wear and tear. I stopped using soaps on my face, and exfolaited with only my hands  and water, whilst in the shower (rubbed face hard); it has all gotten better on it's own.

Your hormones will rebalance by themselves, your brain will reach equilibrium by itself, we don't have to do anything other than to wait.

 

You can 'stabilise' whilst on your drug, and yes heal - but you'll heal to the design of said drug, creating further problems down the line if you ever want to taper off of your medication again. Antidepressants cause oxidative stress, whilst on them, and especially whilst tapering, they will give your skin a harder time when it comes to regenerating/replenishing.

 

You need to reach a certain point, and think 'this is it', say, taper off of your drugs, then leave your central nervous system alone for a very long time for it to fully heal, and for your hormones to rebalance themselves. Whether that's on the drug, or off, you need to have a point/destination in mind to reach, then settle. You don't want to shake up anything any more. If you want to be off of your drug(s), then i think it has to be one at a time, and very very slowly, especially if you want to avoid further worsening of symptoms. But for now, i think you should wait for a while, wait for the new symptoms you've had to go, and for everything to feel a little more manageable.

 

I hope this is helpful in any little way, it's hard when everything we do hurts, and every path that you have infront of you may be scary/seem like it'll hurt, but there are no quick fixes to this, just time, and love, and care, and in that time, everything will stabilise, your symptoms will go, your hormones will rebalance back to normal function/levels, and your skin will get better, along with your hair. Stress can turn a patch of your hair grey, when it's taxing on the central nervous system, and think of people that don't get much, or any sleep for a few days, wrinkles show on their faces, their skin looks old, and tired, these are normal happenings of our nervous system, ones that can be reversed. So it'll be okay, just in time.

 

Icip.

[Guest]

9 hours ago, Emma7855 said:

@Ryguy, no I just got the aging/acne after I inadvertently starting messing with my hormones (I was already in withdrawal at this point). Then I tried various things to reset them, and that only made my situation worse. Now I look around 10 years older than I actually am, complete with white hair and severe wrinkles. It's terrible. What about you? Have you done anything to try to solve it? What are your other symptoms? Have you gotten any windows, or have you just been in one long wave? 

Windows have been 1 percent of my journey , mostly a giant wave foe ten years

[Emma7855]

Thanks for the kind words, @Icip. I hope you're right about the hormones, but I don't see any success stories on here about that, so I'm not sure. I believe I've put myself into perimenopause (complete with all physcal/mental/emotional symptoms) and I'm only 32. I've never heard of anyone reversing that 😔

[Emma7855]

@Ryguy, that's insane that you've been in withdrawal for 10 years and have barely recovered. I'm so sorry. Has Altostrata said anything? Do you take any supplements? And what do you do for the acne? Have you been able to treat it?

[Guest]

23 hours ago, Emma7855 said:

@Ryguy, that's insane that you've been in withdrawal for 10 years and have barely recovered. I'm so sorry. Has Altostrata said anything? Do you take any supplements? And what do you do for the acne? Have you been able to treat it?

 

See Alto's response quoted below (which has been posted in Ryguy's Introduction topic)

 

Nothing helps the acne, if i have a flare up my whole body goes insane including my skin, scars get deeper every single day...this withdrawal has ruined the best years of my life and when i do recover, if i ever do, im left with it stealing from me even when its gone. Ive lost hope basically now, im hanging on just cause i dont know anything else at this point. Yea ive told the website admins whats going on, theyve suggested i look into other health issues, which i have done for ten years, ive tested everything u can imagine...i just cant believe how badly it effected me physically, i didnt know such a thing was even possible, no supplement works, nothings treated anything. 

 

  

2 hours ago, Altostrata said:

Yes, a gut problem and consequent malnutrition can cause many of those symptoms.

 

You could have post-acute withdrawal syndrome AND a gut condition that might be treatable or you may be able to manage it. It's your responsibility to look into possible medical conditions. We can't wave any wands to relieve your symptoms.

 

Edited November 27, 2020 by Guest
Added Alto's response

[Emma7855]

Hello, this might be silly of me to ask, but would it help to slowly increase my dose of Lamictal back up to what I was taking last year, before I crashed? Or would that make things worse? I'm currently taking 35 mg; last year, I was taking 150 mg. Thanks!

[ChessieCat]

1 hour ago, Emma7855 said:

would it help to slowly increase my dose of Lamictal back up to what I was taking last year, before I crashed?

 

In order to assess your situation please provide at least 3 consecutive days of daily symptom notes.  You may be asked to provided further days.

 

Keep Notes on Paper

[ChessieCat]

Please condense your drug signature so that it doesn't take up so much room.  Since the software upgrade, some of the topics appear on the left side of the screen.  I'm using a desktop computer and your drug signature takes up the whole length of my screen so it makes it difficult to read posts.

 

My suggestion would be to remove the bullet points and put the year on the same line as the information.

 

Anything prior to 2020 can be summarised.  You can keep a copy of the existing drug signature in a post for your own records.  You will need to do this before you alter the signature.  And you can also add a link to the post in your signature if you want so it is easier to find.

 

You can also remove the words increased and decreased because you included the doses.

 

• 2015:
  • January: Started taking Xanax (0.25mg) as needed
  • May: Weekend of trying LSD, psilocybin mushrooms, MDMA
  • May: Discontinued Xanax (CT'd)
  • July: Started taking Prozac (0 --> 40mg)
  • November: Started taking Lamictal (0 --> 150mg)
• 2018:
  • May: Tapered off Prozac
  • July: Started taking Klonopin (0.125mg) as needed
• 2019:
  • March: Discontinued birth control pills (~10 years)
  • May: Discontinued Klonopin (CT'd)
  • April --> July: Tapered off Lamictal (150mg --> 0: 125mg for 3 weeks, 100mg for 3 weeks, 75mg for 3 weeks, 50mg for 2 weeks, 25mg for 1 week)
  • Mid-July: Reinstated Lamictal (25mg) after 3 days of discontinuation 
  • Mid-August: Increased Lamictal (25 --> 50mg)
  • September: Decreased Lamictal (50 --> 37.5mg)
  • December: Decreased Lamictal (37.5 --> 35 mg); started taking Trileptal (4 mg)
• 2020:
  • January: Took one birth control pill
  • April - June: Used curcumin cream (daily), 1% hydrocortisone cream (as needed), Elidel cream (as needed)
  • October: Started taking melatonin (0.375mg) nightly
  • November: Had one acupuncture treatment 

 

Currently taking: Lamictal 35mg, Trileptal 4mg, melatonin 0.375mg