Jmizz: Lamictal taper suggestions

[Altostrata]

Yes, windows and waves applies when you're stabilizing.

 

Do you get regular sleep on duty or catnaps? That could be why you have an increase of symptoms while you're working. Having a long break might get your nervous system much more stable.

[Jmizz]

We go to sleep at regular hours just like everyone else, some nights we sleep pretty much uninterrupted, some nights we may have a quick 15-20 minute response or 2 and then back to bed, and occasionally we have a rough night. Last night was one of the rough nights. Most people cat nap mid morning after all the work is done in case we don’t sleep a lot at night, but since my adverse reaction to Zoloft in april, I can’t nap anymore, I get the panic reaction as I dose off. I pretty much only get rest with trazodone, so if I miss my window at work then I’m just out of luck. 

I think it’s a combo of things that make my symptoms worse at work:

 

-around a lot of people
-worried about dose times getting interrupted

-responsibilities that aren’t on my terms

-sleeping away from home

-sleeping with the possibility of getting      called out

I’m hoping this lay off is going to be good for me, one more day!

 

And to answer what you asked yesterday...yes I’m doing a great deal better than I was. Just gotta ride the waves and hope for longer good stretches I guess.

 

[Jmizz]

@Altostrata

 

i forgot to tag you on the response to how we sleep at work. It’s above this comment.

 

So I felt like I was doing pretty good my last 4 day stretch off of work. I think my issues started when I was on the fire the other morning and missed my dose by 45minutes to an hour. Kinda threw me off that day and prob played a part in the headache, maybe more in my system than usual at different times during the day, like you said I’m sensitive to dose timing as well as amounts. So we decided to take 0.5 off the morning dose and add to night dose. can’t really count yesterday bc I didn’t sleep good the night before. But here goes today:

 

530-wake

6-8 relatively the same, little mood dip before dose

8-12 mg

9-1030-pretty activated then seemed to calm down

11-1 decent

1-2-got pretty dosey/slight mood dip

2-5mg

2:30-3 had maybe a little mini activation

4-6 felt decent, cooked dinner for the station with a lot to handle and did pretty well with it

6-dinner

6-8 felt pretty good/slight mood dip before dose

8-20.5mg

8-9 Sinus head pressure/mild headache 

9-50 traz 50/ Mel 5

 

some things of note for you:

 

They aren’t consistent, but I think the slight mood drops pattern is mostly just before dose time. The past couple days I’ve had a few at random times during the day, possibly caused by the 0.5 reduction and less in my system in the day. It’s manageable I just wanted to give you this info.

 

you’re correct that I’m sensitive to timing and dosage amount. I’ve pretty much determined that changes causing less in my system result in predominately nausea, dry mouth, and some shakiness. Changes that result in more being in my system at that time of day is when I get the sinus head pressure and headaches. I think this explains why the 2-8 period seems to be the time I feel the best bc nothing is changing in that time slot. 
 

I think you’re right that the morning dose is too much, too much of a jolt from the 12 hour gap. I’m wondering how you feel about me trying to stay the course on this dosing schedule and Go into this long lay off from work and try to give my system stability. See how that goes and then maybe very very slowly micro taper the morning dose to try and make it to 10 for convenience and hopefully less morning symptoms.

[Jmizz]

@Altostrata

Think I’m fighting a little bit of a wave here caused by the last few days of not so great sleep. Got a little obsessive today, read too much, gave myself a tension headache, mood was iffy, felt pretty sad. Hoping I’ll bounce back with a good night of sleep. Trying to be positive in thinking about the improvements I’ve made the last month, and that if this is a wave I’m having, the symptoms are less severe than they were in the beginning. Maybe this is a good sign?

 

445-woke at work and sort of tossed and turned til around 6, maybe fell back asleep a few times

6-8 maybe a touch dose approaching 8, mood dipped Some before dose

8-12mg

11-12 some anxiety, tension headache most likely from reading on SA, I always start with success stories and end up down a rabbit hole, I have to avoid this from now on, tension pains in neck and upper back, foggy

1230-mild dry mouth, head sensations, mild facial flush

2-5mg

3-5 a little uncomfortable anxiety in public and outside talking with neighbors, had a break from this the past week or 2, foggy brain, mood dips during this period a few times

6-dinner

6-8-ok’ish/slightly dosey right at 8pm

8-20.5 mg

8-9 some head pressure, foggy, mild headache

9-traz 50 Mel 5

 

 

 

 

 

[Altostrata]

Not sure if this is a wave but you seem to have problems when your sleep is inconsistent.

 

Please consider using meditation techniques to get through these rough spots, see

 

Non-drug techniques to cope with emotional symptoms

 

Easing your way into meditation for a stressed-out nervous system

 

Music for self-care: calms hyperalertness, anxiety, aids relaxation and sleep

 

Ways to cope with daily anxiety

[Jmizz]

@Altostrata

yes, you are correct about that. It’s been that way even when I was still lexapro. I guess poor sleep can dig up some of the old symptoms, even had a couple zaps the past couple days...My sleep should be consistent for the next 3 weeks. Thanks for the links. 

[Jmizz]

@Altostrata

 

I’m just over here plugging along. My symptoms have been pretty much consistent for the most part until today. Yesterday I got a new batch of 5mg dispersibles. Same manufacturer, looked like a different handler. Pill looks the same. I took a new one at 2pm today and my anxiety skyrocketed starting about 2 hours after that dose. Like shortness of breath anxiety that is different from most of what I’ve felt throughout this process. Had some brain zaps also. The first was like 5 min after I took it. I went back and looked at the first few days I took the first batch of dispersibles Jan 4-6 and it’s the same symptoms that happened today. I guess maybe this will settle. It seemed to the first time around. It’s frustrating though. 

[Jmizz]

@Altostrata

so up until yesterday my symptoms were like this:

(6-615)- I’ve been sleeping like a rock until right at 6 or so. Muscle and joint pain wakes me up and progresses. Mild burning headache. I toss and turn and normally get up about 7:45 to go take a dose

8-12mg 

9-12 I’ve been having the normal funk but it’s been moreso a general malaise and fatigue just blah feeling, the aches and pains are still there but low grade.

12-2 I normally feel slightly better and then approaching 2 I kind of feel that slight burning headache and get a little more achy

2-5mg

2-4 the post dose funk seems to hit a little quicker after this dose, nothing horrible just a funk blah feeling

4-8 generally in this window I’d have some periods where I feel decent. Seem to get a little dosey before 8

8-20.5mg

9-50traz 5 mel

9-10 fall asleep within the hour 

 

I’m going to lay off the epsom a few days and see if it helps the fatigue

 

i took a new batch of 5mg dispersible yesterday and it seemed to destabilize me. Is this common? Or am I just that sensitive? My anxiety was bad yesterday afternoon and this morning the 12mg activated me the head pressure seemed worse the first hour after I dosed. Nothing changed other than getting the new 5mg pills. As stated earlier I went back and looked and I had the same reaction when I started the first batch for several days.

[Altostrata]

Very strange about the new batch of 5mg. Did you talk to your pharmacist? Any possibility this is a bad batch?

[Jmizz]

@Altostrata

 

No, I didn’t do that bc I remember the first batch threw me for a loop also for a few days. I don’t know if you read the post before the last one. I had the same reaction the first few days I took the first batch also. In my notes you can see I had brain zaps for a few hours Jan 4th and also the shortness of breath anxiety for a couple days in there also. I wonder if the fillers are consistent? I took one of the last batch today to see if it happens again. Active ingredient wise nothing seemed off I don’t think, I didn’t get any dry mouth or nausea... it’s just like something else in the pill reacted bad or something.

[Altostrata]

Was this new batch a different brand? Can you ask your pharmacist to stick with the same brand?

 

If you continue to have problems with the new 5mg tablets, I'd take them back to the pharmacist and ask if they might be defective.

[Jmizz]

No they both read the exact same on the bottle except the handler was a different person. Both came from Glenmark Pharmacy...both look the exact same. The first batch effected me also though. So I guess I’ll just see if it settles. I took one of the old batch today and so far it’s been “normal”

 

anyway aside from that. What do you think about my symptoms. Im curious about when you took Lamictal. I know you took a very low dose, but it never gave you issues? Headaches, body aches? Did you still get waves on AD withdrawal symptoms at times even while on Lamictal? The nausea and dry mouth and stuff from moving doses around drastically has subsided. The body pain is crazy, but I remember having pretty bad aches after the first time I stopped Zoloft, I just didn’t know they were withdrawal bc I was functional and my CNS hadn’t crashed. 
 

it seems if the body aches were 100% caused by interdose withdrawal that they would let up almost completely when I took a dose, but that doesn’t seem to be the case. I prob need to drink more water to help the headaches. I don’t know, I was just curious about your Lamictal experience.

[Altostrata]

Oh, yes, I got headaches and queasiness as startup symptoms. I had to back down in dosage and titrate up very slowly. I checked with my lamotrigine maven and he says those are very common side effects.

 

You are going in the opposite direction, titrating down from a higher dose.

 

Even though you seem to be a fast metabolizer of lamotrigine, by 2 p.m., you still have some of your morning dose in you. The 5mg at 2 p.m. adds to that. The morning dose is wearing off, in the early evening, when you feel the best. This is consistent with lamotrigine half-life.

 

How long have you been taking 20.5mg at night? Has it been a week? Has there been a change in your headaches after the evening dose?

 

It seems to me maybe 12mg at 8 a.m. might still be too much. 20.5mg at night might be 0.5mg too much, too, but I would change the morning dose first to see what happens.

 

Could be that trazodone's metabolite is causing some symptoms during the day.

 

 

[Jmizz]

@Altostrata

The headaches have always been random, I don’t get them all the time, when I do it’s usually always starting early afternoon and continuing into the evening. I get two different headaches, that one I just described is more of a migraine type. The other I usually get as part of my dosey symptoms and it’s more of a dull burning headache. It usually comes on around 1.5 hours before the next dose, it seems. I don’t notice anything different since going from 20 to 20.5 at night, but I take the trazodone around 9 so whatever I might would feel might get masked by that. I’ve been sleeping like a rock.
 

I changed to 3x a day dosing end of December and had a week of that where I didn’t notice the body aches in the am. The body aches in the morning started when we upped my dose at night from 17.5 to 20 and eventually 20.5. So I’m not real sure what causes the soreness. The big dose before bed or interdose withdrawal, just seems like I would have been feeling it doing 15/5/17.5 also if it was interdose.

 

i took one of the first batch 5s today and didn’t notice the intense anxiety this evening, I’ll prob try another new batch 5 on Monday and see. 

 

its possible trazodone gives me issues during the day. I’ve never interpreted it that way, all my issues seem to be dependent on lamotrigene dose and timing, but I’m sure the metabolite may cause issues as well. 

[Jmizz]

@Altostrata

also to answer, it’s been 9 days at 12-5-20.5. 

[Altostrata]

After you get the 5mg tablet settled, you might reduce the morning lamotrigine to 11.5mg, see what happens. Could be you could do with somewhat less in the morning.

[Jmizz]

@Altostrata 

 

sounds good. 
 

I made the mistake of combining the new pills with my old ones. I had one in my truck yesterday I knew was from the old batch and yesterday I did not experience the anxiety surge. Today I took one out of the bottle again, Russian roulette, we will see what happens. It could have been coincidental but it’s just odd that I felt the same way I felt when I took the first one of the first batch, bc it’s distinct from my other symptoms, it’s like a shortness of breath anxiety. 

[Altostrata]

It may just be your sensitivity to lamotrigine. Does this last only a few minutes? Can you breathe through it?

[Jmizz]

@altostrata

 

I get through it, I know what it is now so I deal with it by deep breaths and assuring myself it’s nothing. it came on about 3 hours after my dose and lasted pretty much til bedtime. My son is also sick and I was couped up in the house all day that particular day, so could have just been overwhelmed. Going outside is my outlet. Could be that my withdrawal anxiety convinced me it was a pattern and I just made it worse. 

my aches and pains have been less today. Small victories.

[Jmizz]

@Altostrata

 

See what you think of this, I’m at my wits end haha.

 

2-3-20

7-wake

8-12mg

9-11uncomfortable, slightly queasy, a little achy

11-1 decent 

1-2 dosey some/mood low

2-4 pretty ok

4-tension upper back, touch of pressure, little bit of head sensations 

6-8 couple close to panic feels, seem really dosey, left side headache
8-20.5Mg epsom bath

8-9 headache dull but lingering

9-trazodone 50 melatonin 5

9-10 dull headache still lingering 

 

I wasn’t as achy this morning. Didn’t get the dosey wake up til 7 today. Now it seems like I’m struggling to get to 2pm and 8pm doses. Maybe like an hour before the 2pm dose and 1.5-2 hours before the 8pm. I really hope if I just stick with a schedule I’ll just adjust to it. It’s so annoying. I’m going to give it a few more days and see if things change.

I can’t wait for the day I can stop bugging you. 

[Jmizz]

@Altostrata

 

added on to the symptoms I just sent.

2:45am wake with mild adrenaline surge (this rarely ever happens anymore) fall back asleep 

4:30-wake up wide awake...toss and turn for the next 3 hours

 

 

[Altostrata]

You took 5mg at 2 p.m. as usual?

[Jmizz]

@Altostrata

Yes sorry, I forgot to put it in the notes. 2mg at 5pm, no idea if it was new batch or old batch bc I mixed them together to save cabinet space before I ever took one of the new batch.

 

2-4-20

245am-panicky wake

430am-wake wide awake

4:30-7:30-toss turn/headache/little achy

8-12mg

9:30-little achy

10-11 low mood, some shortness of breath 

12-shortness of breath seemed to ease...maybe a brain zap or two..tingly face and head

12-130 went to park with son, 130 dose feels hit hard/I think I exacerbated it with anxiety bc these last few days have been a struggle

2pm-5mg 

2-3 brutal anxiety/akathisia type...really uncomfortable 

4-7:45 I calmed down and did ok this afternoon...around 7:45 I get antsy 

8pm-20.5mg

8-830 I swear it seems like I got a little zappy after I took it for a little bit, weird bc zaps weren’t even really a big issue for me fresh into withdrawal, for me it’s like an electrical numbing sensation

830-9 just typical post dose feelings of blah

9:30-50traz5melatonin

 

going to ease off the epsom baths for a bit and see if that changes anything. I wonder if my system isn’t liking the change from liquid to pill back to liquid. Who knows, it seemed to settle a few days after starting the first batch so I guess I’ll just see. Something set me off though, it’s been a rough few days, it makes me realize how much better I had been doing by feeling how I felt the last few days. It’s been 5.5 months since my last lexapro pill, so maybe I’m just in some weird horrible wave and Lamictal is struggling to control it. I had been sleeping great, I don’t know what yesterday was about but I hope it’s a fluke and I sleep good tonight.

[Altostrata]

Did you say anything about that batch of 5mg lamotrigine to your pharmacist? It might have been exposed to heat or something, causing it to degrade, or it might be a bad batch. This happens. Counterfeit tablets are a possibility, if your pharmacy bought from an unscrupulous distributor.

 

I am confused. You said you got a batch of 60 5mg tablets in early January (I think it was actually at the end of December):

 

You got a second batch recently? You had around 30 of the old tablets left, correct?

 

Is there any way you can separate the old tablets and the new tablets?

 

In the meantime, you're on a break from work, correct? How about taking the 5mg as a liquid at 2 p.m., like you're doing at night.

[Jmizz]

@Altostrata

 

We changed to 15-5-17.5 at the end of December. I was mixing that 5mg dose with a 25mg tab in water until I got the 5mg dispersibles on Jan 4th. So January 4th was the first day I took a dispersible. 
 

and yes I had 30 or so 5mg left from the first batch, but as soon as I got this new batch I just dumped the old ones into the new bottle to save cabinet space. I hadn’t taken a new one yet or I wouldn’t have mixed them. So now I don’t know what’s old and what’s new. 
 

my 25mg tabs come from zydus pharmacy and the 5mg come from glenmark pharmacy. I see that zydus makes a 5mg. I wonder if the pharmacy would be willing to fill it from zydus so the pills come from the same place?

 

And yes I’m off work, I’ll prob mix my 2pm dose today.

[Altostrata]

I think you need a new batch of 5mg tablets, something is wrong with the ones you got.

 

If you can, you should alert the pharmacy. (Too bad they're all mixed together, the pharmacy could have tested the bad batch. If you spread them all out on a towel, could you tell the batches apart? Maybe a slight difference in color?)

 

In the meantime, you can better control your experiment by using the same liquid at 2 p.m. and in the evening.

[Jmizz]

@Altostrata

 

im wondering if I’m reacting to something in the fillers and the first time around I got used to it and this second time maybe there was more or less filler or flavor and I’ve had to adjust again. I remember my brain zaps came back almost immediately after taking the very first dispersible on Jan 4th. They’ve been coming when I get stressed the last two or Three days again. Either way I’m going to pause on the 5mg tabs. How do you feel about about me taking 0.5 off the night dose so I can take my 5 out at lunch and save the remaining 20 in the fridge and drink it at night? For convenience

 

also I just got back from the psych and advised her of the issue. My pharmacy is restricted in where they get the pills, I told them I was reacting bad to this batch. I tried one more and they also get them from glenmark. They gave me a suggestion of an independent pharmacy to try and see if I can get the 5s from the zydus (same that the 25s come from). Will keep you posted. I’ll try to see if I can differentiate between the last batch and this batch somehow.

[Altostrata]

I would not reduce the evening dose. Can you take 5mg at 2 p.m. in liquid form?

 

Good to hear you can get another batch of 5mg tablets. Suggest you put the ones you have aside for a while, keep them in the fridge. Mark the label so you remember what's in it.

[Jmizz]

@Altostrata

I mixed the 2pm dose yesterday in water. Then I saved the 20 and took it last night. Apologies, I didn’t hear back and assumed that would be ok. So do you recommend I go back to 20.5 tonight or stick with 20. I’m sorry, I was trying to make things more convenient as I’m already bummed about having to mix my 2pm dose and how it effects my daily activity, I’ve been thinking a lot about the XR but I’d need to supplement that with dispersibles...everything is just hard...I’m having a rough week.

[Altostrata]

Okay, take 20mg at night and 5mg at 2 p.m., be sure to keep notes. You're so sensitive to changes....

 

You'll be able to get new 5mg tablets soon, correct?

 

How are you taking the 12mg morning dose?

[Jmizz]

@Altostrata

 

i take all 3 with water now...12,5,and 20. I’ve been taking morning and night in water and the 5mg dispersible at 2, until I got the new batch. I’m due for a new batch of 5s on feb 19th but I could maybe see if they could fill it sooner, do you think I should try the independent pharmacy and see if I can get my 5s from zydus so all my meds come from the same place? Or is the composition of those tablets going to be roughly the same from everywhere?

 

what I did yesterday was take my normal 12 in the am. Then at 2pm I mixed 25ml of water with 25mg tab and took 5ml for 5mg and then put it in the fridge and last night I drank the 20 that was left. I’m keeping it in an old medicine bottle so that it’s tinted. I will keep notes. 
 

I have to concede that whatever issue may have been caused by the new tabs was exacerbated by my anxiety about the situation and possibly an overreaction. I think maybe waiting on the new batch and calming down may be a good move and then if it happens again I’ll know I just don’t agree with something in the makeup of those tablets, do you agree?

[Altostrata]

5 hours ago, Jmizz said:

I think maybe waiting on the new batch and calming down may be a good move and then if it happens again I’ll know I just don’t agree with something in the makeup of those tablets, do you agree?

 

Yes, you have to be careful to separate your anxiety from what you're feeling from the drug. Sometimes this is called developing an "observer." It's important for all of us to have an observer.

 

Do you feel better taking all your doses in the same way?

 

Each generic manufacturer has their own formula, with equivalent active drug (lamotrigine) in it. It's possible you reacted badly to the last generic batch, or it's possible it was a bad batch.

 

Since you seem to be quite sensitive, any drug change may be a little bumpy. Usually this settles down in a few days.

[Jmizz]

@Altostrata

 

its a small sample size. One day but today aside from a couple weird episodes, I think I felt overall better. I also think a lot of my afternoon symptoms haven’t been as pronounced the last two days doing the midday dose off the 25 tablet in water. Tinnitus seemed better, I didn’t get zappy today. No headache until about an hour after my 20mg dose. But that could also be trazodone time doing that. 
 

645-7 my restless wake was around the same time as usual 

8-12mg

8-9 slight activation and maybe a touch of nausea, mostly the typical morning dose funk 

9:30-2 I felt relatively ok

2-5mg water

2-430 felt pretty ok

430- had a weird panicky episode at indoor playground with son, I can’t put my finger on it but I had a slight sensation that triggered me, this has happened before and I get panicky thinking I took the wrong dose or wrong pill but i snuffed it out quick, was pretty anxious after but managed. 
5-730 felt better when I got home, almost seemed maybe a touch “hypomanic” 

730-had another sort of weird episode talking to my wife, felt a little short of breath panicky but it settled. It was close to dose time and I think I’m having anticipatory anxiety since I made a few changes. I’ll work on this 

8-20mg

9-slight headache take 50 trazodone and melatonin 5

also what you said about separating my anxiety from what the drug is doing is something I’m just beginning to learn. 
 

anytime I speak of head tingles and head sensations...and also the flush feeling on my face, I think it’s anxiety. I had a rough couple days and noticed those feelings would always subside when I calmed down. I’ll make note of this from now on. 
 

as always, I thank you from the bottom of my heart for taking your time to help me. I will pay it forward when my day in the sun comes!

[Jmizz]

@Altostrata

can I go back to 20.5 tonight? Or is that a bad idea. You were right,  I had a pretty bad episode approaching my 2pm dose of what seemed like withdrawal shakiness and my anxiety has been sky high since. It was dumb to drop that 1/2mg while making the change from pills to liquid. I should have known and shouldn’t have done it before asking you the first night.

[Jmizz]

@Altostrata

I calmed down this afternoon. I’ll see what happens before my evening dose. I was outside my comfort zone all morning. Could have had something to do with it. I need to cope better but for some reason my anxiety has been through the roof this week. Just wondering if you think it’s best if I go back to 20.5 or it’s better to ride it out!

[Altostrata]

I don't think your slight reduction in dosage was involved, I think the bad batch of 5mg tablets had a ripple effect.

 

Yes, you can go back to 20.5mg tonight.