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Jmizz: Lamictal taper suggestions

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Jmizz

@Altostrata thanks

 

I wanted to ask this as well. I realize there is a lot going on, so respond when ready, no rush. This is sort of how I feel, I can’t trust how I interpret things bc things change so often and I often have knee jerk reactions. I’ve been trying to be more consistent with everything and not panic with bad days. I definitely think it getting daylight sooner has effected the early waking, you’re right. It seems as if I’m maybe in a windows and waves cycle with the AD withdrawal, and when I have a blip of any sort, waking early, increased stress, etcc and my withdrawal symptoms kick up then I become more sensitive to everything including the lamotrigene during those times. I don’t know if you remember and maybe you experienced something similar?

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Altostrata

Yes, all of that may be what's going on. It might take some months for your system to stop being so reactive.

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Jmizz

@Altostrata I’m starting to come to grips with that. Thanks, I’ll continue to ride the waves with coping mechanisms and from now on try to really take it easy on myself when I’m off work, even if I feel good.

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Jmizz

@Altostrata

 

in another good stretch Alto. Have been just living my life for several days now. I’ll occasionally have a little ear pressure, or a mild headache. The tinnitus is always there but doesn’t really bother me. The initial stress and shock with all virus stuff was rough, however I think I was coming down out of a wave and that made it worse. However I seem to have come out the other side better than I was before.  I had a well timed scheduled vacation from work, so in a weird way, I think this virus forcing me home, no outside stress, only having to do the things I choose to do, has been good for me. I don’t really give the virus a second thought, just enjoying time with my family. My appetite has been great. I even eat stuff I prob shouldn’t from time to time, and I’ve actually drank a few cokes during this stretch (I know I know) but they haven’t seemed to effect me much at all. I take this as a good sign. Maybe my sensitivity is improving. I started a new prescription of the 25mg tabs and didn’t notice any difference. I got a two month supply so I’ll be taking the same med for a good long stretch. Sleep has been great again, I slept 9 hours the other night and almost overslept my morning dose. Been motivated, gotten so much done around the house. Maybe my nervous system is starting to settle?

 

how are you? I know it’s rough out your way. Hope you are well!

 

J

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Altostrata

All good, Jmizz. Sounds like you're stabilizing. Stay safe, y'all.

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Jmizz

Hey @Altostrata

 

Update for you:

 

back to work yesterday after two weeks off. Going back always is a little rocky. Could be sleep pattern changes, could be added stress. Way more manageable than before though. I’ve been finding I’m getting horribly exhausted and blah a couple hours after the morning dose and usually again a few hours after the 2pm dose. I had read somewhere you had told someone else as the system settles the medicine may effect us different. Anyway I’m hoping it’s just a weird little phase with the exhaustion. Anxiety still spikes a bit from time to time but I just work through it as best I can. I tend to feel better as the day goes on, mornings are my struggle portion most days. Sleeping fine, almost too good, it’s so hard to wake up in the morning. 


anyway, that’s where I’m at. Hope you are well and healthy!

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manymoretodays

Hi Jmizz! 

Give a current drug and symptom notes.  For us inquiring minds.  B)

Oh yes, please be careful out there Jmizz.

I think I saw you might have a vacation coming?  Oh I hope so.

Looks like overall you are doing really well.  So happy about that.

 

L, P, H, and G,

mmt

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Altostrata
21 hours ago, Jmizz said:

Hey @Altostrata

 

Update for you:

 

back to work yesterday after two weeks off. Going back always is a little rocky. Could be sleep pattern changes, could be added stress. Way more manageable than before though. I’ve been finding I’m getting horribly exhausted and blah a couple hours after the morning dose and usually again a few hours after the 2pm dose. I had read somewhere you had told someone else as the system settles the medicine may effect us different. Anyway I’m hoping it’s just a weird little phase with the exhaustion. Anxiety still spikes a bit from time to time but I just work through it as best I can. I tend to feel better as the day goes on, mornings are my struggle portion most days. Sleeping fine, almost too good, it’s so hard to wake up in the morning. 


anyway, that’s where I’m at. Hope you are well and healthy!

 

Interesting development. Let's see if the tiredness after the first 2 doses persists. You're using the liquid?

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Jmizz

Hey @manymoretodays good to hear from you! I can provide a few days of daily symptoms if you would like soon. For now I’ll just surmise it as best I can. I’m taking 37.5mg of lamotrigene in water broken up into 3 doses a day. 12mg 8am/ 5mg 2pm/ 20.5mg 8pm. I then take my 50mg of trazodone at 9:00pm. Mornings have been rough, afternoons I feel better. I do well it seems when I’m off work and at home with less stress, obviously. I just came off a vacation from work. I’ll be on a regular work/off/work/off/work/4daysoff schedule from now until mid June. My second baby is coming in early July and I’m allowed up to 3 months off if I want to take it all. Based on how this last year has gone and how crazy things are now, I might just take those full 3 months. I’ll try and pay attention to exactly what I feel and when and jot it down for you soon. A lot of my issues come when my anxiety spikes, and I’m starting to learn to distract myself and calm down as best I can. Some days it’s harder than others, but I guess that’s the nature of this beast. Overall I’ve made huge improvements in the last month or two. Thank you for checking on me and I hope all is well for you.
 

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Jmizz

@Altostrata yes. I still use the liquid all coming off the 25mg pills. I don’t know if it was all in my head but I seemed to start seeing some consistent improvements when I stopped the 5mg pills. However this was also around the time I held consistent on the dosing. We had been moving small portions morning to night. I also have learned the feeling of being overstimulated was being mistaken by me as medication effects for some time. It’s a learning process. Last night and this morning was rough, I’ve been trying to block out a lot of the fear and negativity around this virus but some crept in last night and gave me anxiety. I worked through it and this afternoon as been better. I’ll keep you posted on the fatigue. Today maybe didn’t seem as bad. I know some people have said they have random fatigue days in withdrawal, so it could be that.

 

thanks for replying 

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Jmizz

Hey @manymoretodays You had asked for a symptom pattern. I’ll tag @Altostrata as well.

 

The fatigue just seemed to be a random couple of days thing. I’ll let you know if something changes there. 
 

I guess I need some direction as far as a symptoms list. I’d hate to list symptoms on a day that’s just a rough day and it seem as if it’s related to my current medication and doses.  My symptom pattern is hard to nail down bc I think it’s all situational for me lately. As in, when I overstress myself, or my anxiety spikes...I’ll have symptoms. Otherwise for the most part if things are relaxed and easy going, I feel pretty much ok. My stress/anxiety symptoms are left side of my head flush feeling and my ear feels hot (only that side), I’ll get some back and joint  aches and in my groin area, , tinnitus is usually always there but it gets worse during these times. My nausea only comes when my anxiety spikes these days. The only thing that returned lately that seems kind of weird is right before I fall asleep at night, sometimes I’ll get a horrible image in my head and a panicky feel for a few moments, and sometimes just the panicky feel without the image. It goes away quick and then I fall asleep and sleep all night. Would you guys still like me to write out a few days worth of symptoms for you, including some work days and some off days?

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Altostrata

That's good info. jmizz, thanks.

 

You are in a high-stress job, please do what you can to practice meditative breathing at all times. This prepares your system for calming when stress spikes. It has practice in the calming, you send it a conscious message, it will go into the associated calming pattern.

 

2 hours ago, Jmizz said:

The only thing that returned lately that seems kind of weird is right before I fall asleep at night, sometimes I’ll get a horrible image in my head and a panicky feel for a few moments, and sometimes just the panicky feel without the image. It goes away quick and then I fall asleep and sleep all night.

 

This may be a paradoxical reaction, indicating the lamotrigine dosage is too high. The alerting in your nighttime nervous system has ticked down a notch,  it doesn't need as much help from lamotrigine. You might decrease the nighttime dose by 0.5mg lamotrigine.

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Jmizz

Ok @Altostrata I’ll reduce the nighttime dose by 0.5. Do you expect much of a hiccup from this? I start my next 4 day stretch off of work on Friday. Should I wait until then?

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Altostrata

Don't expect a hiccup. Waiting until Friday is a good idea.

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Jmizz

@Altostrata


Hi alto. Last we spoke we had talked about the weird jerking awake/bad image/panic moments as I was dozing off for sleep at night. They only happened a handful of times, sometimes just a jerk awake, sometimes the bad images accompanied. I had a few days with no issues there and you had recommended taking 0.5 off the night time dose. So I waited til Saturday while I was off work for a few days. I was nervous to take the full 0.5 so I started taking 0.25 out of my nighttime dose on Saturday night. Sunday was fine, a pretty good day. Monday was pretty shaky, the morning dose hit hard and it’s been some time since it seemed to activate me that bad. Monday afternoon/evening was relatively ok though. This morning, back at work, it hit me hard again. Today so far has been my roughest day in probably a month or so. Usually afternoons are better so I’m hoping today turns around. I don’t know if it’s just coincidence and I was about to hit a rough patch regardless, or that even that slight reduction is having some effects. I just thought I’d update you. 
 

last two days:

 

4-20

wake between 4-5 fall back asleep (this is a hallmark of rough patches)

8- awake for good/dose 12mg/breakfast (appetite is taking a hit the last couple days)

930-11 pretty uncomfortable, activated restless

11-took my son on a walk around the pond

12-2 at lunch didn’t feel as activated

2-dose 5mg

3-4 seemed a little shaky

4:30-8 was pretty ok

8-dose 20.25 mg

9-50mg trazadone 5mg melatonin

10-sleepy by 10, fell asleep easy 

 

4-21

wake 3am fall back asleep 

5- up for work 

6-8- at a different station so I was uncomfortable but I was the last 4 days I’ve worked and this morning was rougher

8-12mg and breakfast

830- I seemed to feel it quick this morning was uncomfortable up until about 1030

1030-2 I wasn’t as activated feeling but just overall uneasy, some low mood stuff and sadness that’s been gone for a while, pretty anxious for no real reason.

2-5mg

 

thats where I’m at so far today. 
 

thanks in advance for your time,

Jmizz

 

@manymoretodays you had asked last week. Thought I’d tag you. I need to post a withdrawal normal day symptoms wise for comparison. I’m sorry.

 

most days the last 2-3 weeks are as follows

 

-i wake 5am for work 8-830 when off 

8-dose 12mg with breakfast

930-11 I usually go into a very manageable lull during this time

11-2 I don’t notice much, just living life, some days I’ll get fatigue around that 2pm dose but I think that’s when I’m in stretches of work waking up at 5-6 every morning 

2-dose 5mg

2-8 my afternoons are usually pretty good, haven’t really noticed a whole lot in the good stretch I was in

8-dose 20.5 

9-50mg trazadone 5mg melatonin

10-11 usually sometime between 10-11 I get sleepy like can’t hold my eyes open sleepy and a few times the past few weeks as I dozed off I would jerk awake sometimes accompanied by a bad image or scary thought

11 on- sleep like a baby 

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Altostrata

I'm going to guess those bad patches are coincidental, Jmizz. Please hang in and keep those notes.

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Jmizz

@Altostrata

 I’m curious as to how your lamotrigene taper went for you. If you don’t mind or can remember. I’m wondering what pace you went at and if you felt withdrawal, and how long it took for you to get off the dose you were on. I mean I’m pretty obviously not stable enough for that yet, just curious. I think I read somewhere that you don’t like to talk about your own experiences, so I’m sorry if this is out of line.

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Altostrata

At most, I was taking 1.5mg lamotrigine. I tapered very slowly. No problems.

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Jmizz

@Altostrata

 

ahh! Man I sure wish I’d found you before I got on 50 mg. 37.5 seems so far from zero when I’m having rough days. Encouraging you had no problems. I think I’m going to ease my way to 20 for the night time dose over the new few days. You’ve said this all along and I had been doing pretty well so I never adjusted, but I think you’re right, I prob need to work on getting that morning dose down some at some point. That 9-12 window is consistently the worst part of my day, even though it’s so manageable on good stretches.

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Jmizz

@Altostrata

 

3-wake fall back asleep 

530- wake drive home

615-8- laid in bed, restless legs, tried to doze a few times and got adrenaline rushes

8-12mg and ate a banana and cinnamon roll

930-11 some anxiety and restlessness 

12-2 just off from how it’s been for a while 

2-5mg

3-don’t feel well, just queasy and blah

4-8 pretty rough bout of depression I haven’t felt in a long time

8-20.25mg

9-50 traz and 5 melatonin 

10-nausea 

 

it sure seems that I’m reacting to the small drop alto. Day after drop was fine. Day 2 was shaky. Day 3 and 4 have been pretty rough. I was reading some of Brassmonkeys posts about the timeline following cuts. He usually said symptoms would clear by day 6. So I’m hoping to feel better in the next day or two. This is pretty discouraging :( Will it be easier once I settle more from the SSRI withdrawal?

 

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Jmizz

@Altostrata 

After posting the last post with my symptoms the last few days, I went back through my notes back for a while and it seems any sort of issue that causes an unbalance in the dosing schedule has about a week of adjusting behind it. Moving small portions from morning to night, daylight savings. I guess this will pass and maybe I should just try my best not to change anything at all for some time.

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Altostrata

Yes, that makes sense. You seem to be extraordinarily sensitive. Do you think you can hang in for a few more days? The change should work its way out.

 

After this, it might be a good idea just to coast on your current schedule for a good while.

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Jmizz

@Altostrata

yes. I plan to just deal with this until my body sorts itself out. It’s just confusing, I don’t understand why a drop in medication causes nausea when I take my doses afterwords. I’m worried about how sensitive you think I am. I know it’s probably just anxiety. I know you don’t like to speculate at all, but in your experience does being this sensitive mean it will take longer to become less sensitive, or is it something that can improve relatively quickly when it improves. I mean I’ve seen some improvements in sensitivity to foods. Is the idea that I should coast a long time and it will hopefully be easier once I’m more stable? I keep telling myself I’ve really only held on a consistent dose schedule for around 1.5 months and saw a lot of improvement in that time. I guess if nothing else this shows that my water solution system is very accurate for the most part. I just wish there was a way to make dosing more convenient. 

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Altostrata

People have reported nausea as a symptom when they reduce lamotrigine. It has no greater meaning that I know of. Let's expect it will go away in a few days.

 

While it seems your body may have been saying "a little too much lamotrigine", it may not be entirely stabilized yet from your prior drug changes -- but it may be getting there. It's a process!

 

Eventually, you'll be able to go off lamotrigine and probably trazodone, don't worry.

 

Please keep in touch.

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Jmizz

@Altostrata

thank you as always.

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Jmizz

@Altostrata

 

Hey. I’m still roughing it out over here. It’s not all horrible just a pretty big slip back from where I had been. This is just conversation, but I’m curious about the 25mg extended release lamotrigene. How long does that generally stay in the system, and for my dose somewhere around 37.25mg, if I ever considered that would I just take a mixed 12.25 in the morning  as a supplement? Or is this just a horrible idea to consider altogether?

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Altostrata

What's going on? Any pattern?

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Jmizz

I hate myself for not simply jotting down notes. I have to do better. It’s just when it hits me, I just go into survival mode and I never stop to think about writing down things, I’m just trying to make it til the evening when most times I feel somewhat better. I’m going to do the best I can to explain what happened.

 

So  I dropped the 0.25mg off the evening dose as you know. 4-18-20. Here’s what changed.

 

-still sleeping fine but wake several times throughout the night and fall right back asleep
-restless legs feeling ticked up in the mornings before I get up for good
-foggy overwhelming sensation handling things I’d been doing with ease

-felt a little shaky as doses approached

-felt more activated after doses and then some nausea a couple hours post dose...was worse with the night dose that was tweaked

-fought off a couple urges to just break down and cry, mainly in the 3-7 day stretch 

-depression, racing thoughts, neuro stuff (mainly fear and sadness..some anger at times) but my doses seemed to trigger the racing thoughts and depression/sadness/fear big time for several days, it seems to be diminishing with time however.

 

Physically, aside from the decreased appetite, shakiness, and uptick in nausea...it hasn’t been debilitating. This has been more of an emotional spiral. Doom cloud. And disregard my previous post. I despise the midday dose. Taking doses in water mixed seems overwhelming when I spiral. The preparation for work, making sure my doses are mixed and then making sure they are accessible to me at all times at work and even off work being out and about is exhausting. It just gets worse when I spiral emotionally. I just wish I could somehow eliminate it and that’s the reason for my question earlier, but I know I can’t make any decisions about anything like that until I come out of the other side of this funk and am thinking more rationally.

 

sorry for the long message. I know I’m way better than I was. Maybe this is that bad wave everybody talks about on top of the small dose drop, idk. Im coming up on 9 months off Lexapro and about 18 off of Zoloft mid May.

 

 

Tom-Servais-Tahiti-Surf-Pro-2017servais1

 

 

 

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Altostrata

Can you move 0.25mg from the morning dose to the evening dose?

 

Is work more stressful than usual?

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Jmizz

@Altostrata
Im in a long stretch of normal work schedule. The past few months I’ve worked a couple weeks and then had time off, which meant a couple weeks of sleeping for 8-9 hours instead of 6-7. This means in a given week currently I’ll get 6-7 hours for 4 days and then 9 or so the other 3. The other day 4-30 was a particularly busy day, but otherwise nothing has really created any stress other than usual. 
 

So I didn’t think the 0.5mg drop would be a big deal so my plan was to eyeball the middle of two lines on my syringe for a few days and then go up to the next line. It effected me so much I didn’t do anything and then I was kind of caught in no mans land with no reference to make sure I’m drawing out the same amount. I figured out a solution but in doing so I may have taken just a tiny bit out again. This was a few days ago. It’s possible I rolled from one adjustment into another.
 

I try to listen to you and also my body. I kind of think maybe it’s best if I hold tight on everything and try to let this sort itself out. I would like to get some of the load off the morning dose for sure, I’m just worried about the weird sensations I was getting before bed at random times. Also, I know it’s possible to feel okay on these doses, bc I was just doing it the last few weeks before I dropped the small amount?? So confusing.

 

As far as the reason we decided to shave a little off the night dose. Do you think the fact that I was feeling better and started stimulating myself before bed more with tv shows I hadn’t been watching for some time maybe was playing a part in the weird jerking awake feeling before I fell asleep. Bc they didn’t happen everyday, seemed random and I’m wondering if it was on the nights I stimulated myself more before bed?

 

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Altostrata
19 minutes ago, Jmizz said:

As far as the reason we decided to shave a little off the night dose. Do you think the fact that I was feeling better and started stimulating myself before bed more with tv shows I hadn’t been watching for some time maybe was playing a part in the weird jerking awake feeling before I fell asleep. Bc they didn’t happen everyday, seemed random and I’m wondering if it was on the nights I stimulated myself more before bed?

 

That is possible. I know when I'm on the computer too late, I have trouble falling asleep.

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Jmizz

@Altostrata

 

think I’ll just see how things play out for the next week or so and see if things calm down. Then maybe look into moving a little to night time. I wanted to ask, is it possible to overcome kindling, or is that something that lasts indefinitely? I don’t guess I fully understand kindling.

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Altostrata

Kindling is a drug reaction. You can avoid or manage the drugs. Nervous system hyper-reactivity or hypersensitivity very gradually decreases over time.

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Jmizz

@Altostrata

ok. I was under the impression that kindling meant each withdrawal gets harder. so there will be a point in my life again where I won’t have to be terrified of getting an infection and needing an antibiotic? And maybe even one day way down the line I could possibly enjoy a drink with friends again?

 

sorry a million questions and mind wandering when I’m struggling. Last one. Then I’ll update you in a week or so.

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Altostrata

Yes, your drug sensitivity will slowly decrease.

 

You do not appear to be in a kindled state. Your metabolism of lamotrigine is complex, it appears that something is going on that was triggered or coincidental with that small decrease.

 

I am even wondering if your body wants you to decrease the lamotrigine more. As your nervous system calms, it may rebel against the lamotrigine dampening effect. This was the earlier sign we discussed. It could be the calming has progressed and your body wants even less.

 

Queasiness can mean a bit too much lamotrigine. This is complicated by queasiness also being a withdrawal symptom.

 

It seems you're still getting a bit of activation after the morning dose, another sign of too much..

 

Please post more daily notes.

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Jmizz

I think it’s important to compare to when I was feeling good a few weeks ago before the drop. my days were like this.

 

-sleep good until I had to get up, wasn’t really waking other than brief and right back to sleep.

-8am 12mg

-9am-11 maybe a small funk, nothing I couldn’t handle 

12-2 pretty normal unless triggered or overly stimulated 

2pm-5mg

3-8 pretty normal unless triggered or overly stimulated
8-20.5mg

9-50 traz 5 mel

10- usually around 10-1030 id get sleepy and randomly some nights I’d startle when falling asleep

 

today:

5:30 slept fine, woke a few times and back to sleep...up for work 

6-8 manageable, tried to do a crossword, seemed a little too stimulating 

8-12mg

8-10 did ok

10- awful anxiety, kind of heavy chest pre panicky lasted til around 12-1230 

1-2 felt better

2-5mg

2-5 not bad

530-8 kind of racing thoughts about all of this, not much in the way of physical stuff just an emotional funk about everything and can’t stop thinking about it

8-20.25mg

8-mild headache the last two nights between 7-9...hadn’t had headaches for some time 

8:45 some nausea just blah

9-traz 50 Mel 5 moderate nausea and headache continue

 

ill do it again tomorrow. At work things can be skewed. I feel like maybe I dropped a little more off the night dose a few days ago trying to give myself a consistent mark on my syringe, it prob wasn’t much at all but thinking maybe I’ll have a couple days of nighttime nausea again 
 

I’ll mention this as well. After the adverse reaction/really late reinstatement of Zoloft in April last year, they switched me to Lexapro. After a few days of 10mg I seemed to get relatively stable and didn’t feel the medicine. Had a pretty good week or so. Drinking a few days screwed me up and afterwords my doses would make me feel activated like the lamictal does now. I then went to 20mg and got used to that after about 9-10 days and didn’t feel it anymore and same thing, had a good week and then drank a few days without knowing what was going on with me and then the 20mg made me horribly activated for the next 3 weeks until I started to panic taper off. I don’t know if that info helps
 

i think I may have to try and level back out for a week or so and then see how the symptoms compare to how I’m feeling now. Do you agree? 
 

 

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