Jump to content
Jmizz

Jmizz: Lamictal taper suggestions

Recommended Posts

Altostrata

Yes, you could always hold for a week to see if you level out.

 

The nausea is queasiness, correct? If these symptoms get worse in this pattern, my hunch is your body is saying it want less lamotrigine in the morning dose.

Share this post


Link to post
Jmizz

@Altostrata

Ok I will keep you posted. Yes it’s just like a queasy blah feeling and my mouth tends to get dry to some extent. Same feeling I got dropping from 50-40 early on and spacing doses... that was obviously way worse but I’ve pretty much gotten some level of this everytime I tweaked doses thus far, even if the amount didn’t change, just the amount at certain times of day. The morning dose is definitely too much, I just don’t know if I’m ready to reduce it, at least when I was staying perfectly consistent for a couple weeks, it was very very mild. I’ll let you know how consistency goes for a week or so.

 

 

Share this post


Link to post
Altostrata

Right, but with lamotrigine being such a tricky drug, as your nervous system has stabilized, it wants to throw the lamotrigine off. As you're feeling progressively better, the lamotrigine has progressively less benefit. So it makes sense the morning dose, which always was bumpy, got more bumpy.

Share this post


Link to post
Jmizz

@Altostrata

 

5–3-20

630-wake slept good

7-arrive home, feel fine, mind just wants to be off meds, can’t stop thinking about it, almost Obsessive

8-12mg

830- start feeling it, tingly, mind racing about things

11- lets up some, have the urge to do something to keep my mind off it

1230-2 some fatigue/uncomfortable queezy at store, but I prob would have felt this way before the drop

2-5mg

3-6 outside staining patio cover, felt fine it seemed but I just kept busy 

7-dinner

745-digestive upset

8-20.25 mg

9- traz50 Mel5

915-digestive upset

930-seem kind of shaky 

 

going to keep holding and see if things sort out. I know the morning is too much, just not sure what to do at the moment 

 

this is so odd. It feels as though I would be completely good and functioning if I wasn’t taking lamotrigene. My mood is doing funny stuff and seems to be triggered by the doses...more so then morning, I don’t feel a whole lot in the afternoon dose...but I’ll concede a lot of the mood has to do with me obsessing that I’ll never get my life back fully with all this medicine mixing taking up so much time and making me scared to go places for fear of not being able to get my 2pm dose in. The way the medicine makes me feel is almost smaller scale the way cymbalta and buspirone made me feel for the short trials. Like it pushes me into an almost manic like state until it wears off. My mind just obsesses and seems hard to turn off. But I remember feeling this way a year to 14 months off zoloft too before I tried to go back on medicine. Just seems like some really weird wave. I feel a lot better in the afternoons. That was how that wave was too.  I just don’t understand how I was feeling so much better a few weeks ago.

 

could the fatigue days I was having before the drop be a result of my nervous system calming also? I have never really felt any sort of calming as long as I’ve been on this stuff, but maybe on those days it was working more like it’s supposed to? Idk

 

is it possible the adjustments just make the morning dose hit harder, and not all of it is withdrawal-ish symptoms?

Share this post


Link to post
Altostrata
16 hours ago, Jmizz said:

The way the medicine makes me feel is almost smaller scale the way cymbalta and buspirone made me feel for the short trials. Like it pushes me into an almost manic like state until it wears off.

 

This is a sign that your overall dose is too high. How about shaving a bit off the morning dose?

Share this post


Link to post
Jmizz

@Altostrata

Ok, how much do you recommend I shave off? 

Share this post


Link to post
Altostrata

How about 0.25mg off the morning dose?

 

Your experience with lamotrigine for withdrawal symptoms is going as it should. Lamotrigine is helping your nervous system settle down. You'll have stretches where you feel pretty good, then your nervous system will say "I don't need so much lamotrigine!" and produce symptoms such as activation, headaches, and queasiness. 

 

This may move along pretty quickly, with small reductions every week or two. As you seem to be a fast metabolizer, changes will ripple through your system fairly quickly. Very small decreases more often are preferable to larger decreases.

Share this post


Link to post
Jmizz

@Altostrata

ok, so in other words, things may get a little rocky for a few days each time but I may be finally starting to make progress towards getting off lamotrigene? Would we still implement holds every so often? How long did you take to go off your 1.5mg? 
 

last question. My last reduction was April 18th. But then I got kind of messed up on my syringe so probably 4-5 days ago I may have shaved a tiny bit more as I tried to get a new marker. Should I wait a few more days or do you recommend 11.75 tomm morning?
 

sorry just kind of excited I may finally be going the right direction. I know you are busy with other folks so please feel free to get back to me whenever!

 

 

Share this post


Link to post
Altostrata

Yes, you are moving towards going off lamotrigine.

 

I would try 11.75mg tomorrow morning.

Share this post


Link to post
Jmizz

@Altostrata

 

Hey alto. Wanted to update and run something by you. So I’ve held at 12/5/20.25 for the time being. Mainly bc I have a big weekend coming. I’ll be driving the truck at work Saturday at the busiest station in the city and Sunday is Mother’s Day. Another reason I held is I really felt like I was withdrawing from that small drop. Things were going pretty well and manageable until 2 days after that small drop so I really wanted to hold on for a minute and see if things calmed down. I feel like I’m close to baseline where I was before the drop now. The medicine hasn’t been as activating the last couple days. Mood is better, minus maybe a spell here and there. Anxiety is down. I get extremely tired between 12 and 2 and then again not long after my 2pm dose and it seems to lift around dinner. Anyway it seems maybe I’m too fragile to drop? The main reason I felt like it was withdrawal from the small drop was how bad the depression got for several days. Anyway if it seems like maybe I’ll be stuck on the dose to stabilize more, I had this question for you.

 

I take 3 doses per day right? The morning dose seems to always be the worst bc it comes after the 12 hour layoff. I’m curious if I slowly incremently slid most of the 5mg afternoon dose to the evening dose, maybe that would make that morning dose less severe and help with the fatigue during the day. I was thinking move 4.75 to the evening very very slowly and then throw the other 0.25 on the morning dose and that way I could actually take a pill at night and only have to mix one dose that id take first thing in the morning?

 

I often wonder if the reason we went to 3 times a day wasn’t due to rebound anxiety from the ativan I was still taking occasionally back then. If I did it super slow, maybe I could get rid of that mid day dose, which causes me tons of anxiety working it into my day. And maybe get the bulk of the medicine to the evening dose where I can sleep through it with the trazodone. Just wondering what you think? I may be way off base.

Share this post


Link to post
Jmizz

@Altostrata

 

sorry I know I’m all over the place. Something spun me out and I’m struggling to recover. I know the morning dose gives me a pretty bad adverse reaction. It seemed way more manageable before the small drop off the night dose. I’m having a tough time deciding if my body is telling me to drop some off the morning or hold still and settle down. I’m pretty terrified to drop another 0.25. So I’m just trying to figure it out

Share this post


Link to post
Altostrata

I would move 0.25mg from the morning dose to the nighttime dose. This will reinstate the nighttime dose.

 

We had discussed how you must be metabolizing lamotrigine more rapidly.

Share this post


Link to post
Jmizz

@Altostrata

 

ok that sounds a little safer to me. I already mixed my doses for tomorrow so I will do this starting Sunday.

 

maybe this explains why my sleep has been weird since I dropped. I still sleep, just seems lighter and with more waking. 
 

Yes, I know we discussed how it seemed i metabolize it more rapidly. It’s just weird to me that I seem to feel so much better before all my doses and I was thinking maybe if the afternoon dose was gone I would feel fine and make the morning less intense. 
 

as far as the fast metabolization. When I quit lexapro, the wheels fell off between days 18-21. I see where lots of people don’t feel the effects of CT for a few months, does this mean I prob metabolized lexapro fast also? I may just metabolize everything fast.

Share this post


Link to post
Jmizz

@brassmonkey

 

this math is going to get fun. I’m trying for 11.75mg. And still have enough to make my 5mg dose also, so I only use 2 pills per day.

 

25mg pill in 20ml of water. 10ml syringe. I have it at 1.25mg per ml. So 9.4 would be 11.75mg and then take 4 more out of the 20 for my 5mg. So 9 plus 2 lines on the 10ml syringe should get me 11.75mgai?

Share this post


Link to post
brassmonkey

Yes, that should work.

Share this post


Link to post
Jmizz

@Altostrata

 

hey friend. I know you are probably getting frustrated with me. I apologize in advance. Just trying to figure all of this out and take your advice and try to balance it in my day to day life and still be able to work is tough and take care of my son. I haven’t changed anything yet bc I was hoping my system will settle back down, and also I’m trying to time it right if I do it so any shakiness will be while I’m off. 
 

when the first put me on lexapro after the essentially failed Zoloft reinstatement. I got to a point twice where I felt pretty stable and didn’t feel the medicine. When i destabilized myself with alcohol before I knew better, the lexapro would then be horrible activating. It settled once but then I did it again and after 3 weeks it was just as activating. That’s when I fast tapered off with no knowledge.

 

do you think the small drop destabilized me in a similar way and that’s why the medicine all the sudden feels activating when 3 weeks ago I barely felt it. If that’s the case I’m wondering if I just need to surf. In the end I will take whatever advice you think is best. I just feel really unstable.

 

not second guessing or intentionally trying to not listen, I’m just trying to provide you as much info as I can before my next move bc I seem to barely be holding on to functioning at the moment.

 

i write you a symptom list this evening

 

 

Share this post


Link to post
Altostrata

I guess it was the small decrease, Jmizz. It's easy to see if putting it back changes anything.

Share this post


Link to post
Jmizz

@Altostrata

 

Im willing to try this, has it not been too long to change back though. I changed on April 18th.

Share this post


Link to post
Altostrata
On 5/8/2020 at 5:10 PM, Altostrata said:

I would move 0.25mg from the morning dose to the nighttime dose. This will reinstate the nighttime dose.

 

We had discussed how you must be metabolizing lamotrigine more rapidly.

 

Are you still feeling the early dose?

Share this post


Link to post
Jmizz

@Altostrata

 

yes I am. I’m just making sure we are on the same page. When I took the 0.25mg off the night dose I didn’t move it to the morning, I just completely removed it from my overall dose. I just got a little confused with the last message. I didn’t know if you wanted me to keep the morning dose at 12 and add back the small drop to the nighttime dose. Or to remain with the drop and move 0.25 to the night. Sorry!

Share this post


Link to post
Altostrata

Yes, I thought you might do with less lamotrigine overall, but maybe moving it gradually to the nighttime might work. The larger lamotrigine dose at night provides coverage through the night, then it wears off in the morning. Could be that very little bit left in you in the morning is a good amount for you and you don't need such a large a booster dose in the morning.

Share this post


Link to post
Jmizz

@Altostrata

 

gotcha. that makes sense to me. Ok well I’ll see how this goes. Thanks

Share this post


Link to post
Jmizz

@Altostrata

 

so, are you thinking eventually try to get to two even doses morning and afternoon and the bulk dose at night? Or just move some from morning til night and see how it goes little by little?

Share this post


Link to post
Altostrata

Yes, you're on a path to gradually go off lamotrigine altogether. It looks like we'll have to be careful, you're so sensitive.

Share this post


Link to post
Jmizz

@Altostrata

 

ok off work for a few days. Tomorrow I’ll take 11.75 in the morning. If you were me would you take 20.5 tonight and 11.75 in the morning or do 20.25 tonight 11.75am and add the 0.25 back tomorrow evening?

 

pray for me, hope it’s not too bad

 

the last few days haven’t been that bad, still feel just gross around 9-11 and then again at 4:30-5:30 on a smaller scale.

 

i know I have to make the adjustment, just hope it isn’t too rough so I can maybe get that morning dose down relatively quickly.

Share this post


Link to post
Altostrata
1 hour ago, Jmizz said:

20.25 tonight 11.75am and add the 0.25 back tomorrow evening

 

I think you'll be fine.

Share this post


Link to post
Jmizz

@Altostrata

 

seems to be going pretty well. I just had my 4 days off. The last few days have been even better than the last good stretch I had. It seems like every time I hit a rough patch, I come back better than the last time. This last wave was awful, so maybe big improvements are coming. I think it’s been 3 days of 11.75/5/20.5. Back to work tomorrow. 9 more working days until a 2 week vacation. I’m going to give it a few more days and then give you my symptom pattern. To see if anything changed or just got milder in the same pattern.

Share this post


Link to post
Altostrata

That's good news. Lamotrigine is finicky to dose. I think you're getting a better idea of its signals.

Share this post


Link to post
Jmizz

@Altostrata

 

hey, I was just curious. People that say they were in acute withdrawal for a set amount of time. What differentiates between acute and PAWs. I’m just curious if I would be considered acute still. Or maybe the waves set me back to acute. No rush I was just wondering the difference.

 

im doing ok. I had a few really good days after I moved the 0.25 from morning to evening, but then my body adjusted or caught up and the last several have been a struggle. This is not surprising as it’s seemed to follow this pattern anytime bobble anything at all with the medicine. 

Share this post


Link to post
Altostrata

The definition of acute withdrawal is arbitrary. It doesn't really apply to you because you're taking a drug to mask withdrawal from another drug.

 

What times of day are you getting troublesome symptoms? Need to see daily notes again.

Share this post


Link to post
Jmizz

@Altostrata

 

I will post some notes soon. I’m fighting off some sort of allergy attack or something, so I’m not sure what’s what at the moment. I feel pretty rough but it seems different than withdrawal stuff. I’ll still keep notes but when I get back to baseline and consistent for a few days I’ll post.

Share this post


Link to post
Jmizz

@Altostrata @brassmonkey @manymoretodays

 

hey guys, so I seemed to have completely destabilized. Or hopefully I’m just going through a god awful wave from the lexapro. It all started with the 0.25mg drop on April 18th to make 12/5/20.25. Prior to that I was feeling the best I had in a long time, the adverse effects of lamictal were so mild I barely noticed. I had some pretty wobbly days in the next couple weeks so we moved 0.25 from the morning back to the evening dose for 11.75/5/20.5. That was on May 16th. I’m so all over the place right now I’m trying to keep notes but it’s like all day and no pattern like it had been.

 

5-27-20

0700 wake slept fine with weird dreams

0800 11.75mg

0900 akathisia or activation/agitation

1100 went outside it let up some

noon-2 zombie fog fatigue irritable

2-5mg

2-3 I felt a little better

3- mini activation 

430-let up some

5-7 foggy fatigue I mean zero energy/really irritable a few times/queasy but I barely ate all day it let up some after dinner

8-20.5mg

9-50mg trazodone/5mg melatonin

 

yesterday was pretty similar...took a little longer to get tired but I was stress reading on SA

 

i feel like stress has a lot to do with this. But it’s bad. Worst I’ve felt in 4-5 months. I think maybe not having any vacation from work for a while as well as everyday stress has caught up to me. I got really stressed the other night with my wife talking about a vasectomy at some point after my next kid is born. I just don’t think that’s an option for somebody as sensitive to meds as me, at least not for a while. So I’ve been stressed and I had my kid all day by myself two days in a row, which is work but I’d been handling it way better for some time. I don’t eat good when I feel this way and I’m sure that contributed to some of the physical stuff like fatigue and being queasy.

 

i just don’t know...I know my body doesn’t like lamotrigene, I knew that before I found you guys. I just don’t know the best way to fix it. I don’t understand why the end or march and beginning of April, I had a really good stretch on basically the same dose and times and now I’m so all over the place.

 

I guess I’m more or less venting. Just curious what you guys think. I will continue to keep notes.

 

Share this post


Link to post
Altostrata

Looks to me like Lamictal is telling you to decrease the 8 a.m. 11.75mg dose. How about to 11.5mg?

 

When you take too much Lamictal, it can be activating.

Share this post


Link to post
Jmizz

@Altostrata

Ok. Do you think the reason the last 0.25 drop went so poorly for me is bc we took it off the night dose and made the morning worse and if we took it off the morning, it may not have been as bad? Also I guess I should pay attention to my symptom pattern so I can gauge how the drops will go whenever I start to  taper more.

Share this post


Link to post
Altostrata
15 hours ago, Jmizz said:

@Altostrata

Ok. Do you think the reason the last 0.25 drop went so poorly for me is bc we took it off the night dose and made the morning worse and if we took it off the morning, it may not have been as bad? Also I guess I should pay attention to my symptom pattern so I can gauge how the drops will go whenever I start to  taper more.

 

Yes, that might be it. From your symptom pattern, looks like the nighttime dose is fine but the 8 a.m. dose is causing problems. It could be that by 8 a.m., you still have some of the 2 p.m. + nighttime dose in your bloodstream (5mg + 20.5mg), the addition of the 11.75mg dose in the morning kicks it up too much.

 

The morning dose has showed signs of being too high before.

 

Once your system starts calming down, it doesn't like to be slowed too much by lamotrigine and responds with paradoxical symptoms such as those you get after the morning dose and a little bit after the 2 p.m. dose. When you reduce the 8a.m. dose, this reduction will trickle down to the 2 p.m. dose as well.

Share this post


Link to post
Jmizz

@Altostrata

 

i mean it makes perfect sense based off of how I feel, exactly like you describe it. Immediately after the morning dose I get agitated, a couple of the past few days I had some fleeting random SI...but after about 2 hours then I get bombed with fatigue. It’s like my system fights it and then gives in and I just get tired. I’m just a really weird case I guess. I hope I don’t withdrawal too bad off the small reduction.

 

thanks as always

Share this post


Link to post

Please sign in to comment

You will be able to leave a comment after signing in



Sign In Now
×
×
  • Create New...

Important Information

Terms of Use Privacy Policy