ThroughTheForceField: Hello everyone.

[ThroughTheForceField]

Hello everyone. I've been on Lamotrigine, Mirtazapine and Escitalopram since 2015. I got this combo after a lot of trial and error with various meds during 2007-2015. I'm not sure if I need to mention those previous drugs because they're long gone. Right now. It's only these 3 that matter.

 

When it comes to tapering, I use the well-known method of crushing the pills finely and dissolving them in water. Currently, I don't intend to go off the meds completely. I can't survive that. I just wanted to reduce the doses to alleviate some of the negative cognitive effects they have. I'll write more about this and my problems in a future forum post. I don't feel ready to write all that just now. I also want to know more about side effects, withdrawal effects etc.

 

The worst of the three drugs to reduce is the Lamotrigine. The withdrawal from that is just horrendous (it’s fine for the most part when taking, it’s just reducing/leaving that’s the problem). I don't know how I'll ever manage to come off it even if I want to take something else.

 

I've found that the way I feel depends on how much of a drug I take and also what the concentration of the solution I take from is. Taking 3.4mg of Escitalopram from a solution where I've diluted a 5mg Escitalopram pill in 25ml of water feels very different than taking 3.4mg from a solution where I've diluted a 5mg pill in 50ml of water. The latter makes me feel terrible actually. I've been experimenting to find the right dose and dilution. I've definitely been able to remove some degree of negative side effects.

 

I know the mods and several members here are knowledgeable about all this and there are all sorts of tapering calculators and spreadsheets you’ve already come up with. I haven’t gone through them so I don’t know if anyone has already posted something like this. However, if anyone is interested, I wrote a simple Python script to calculate what volumes of water you can take and what volumes you have to remove if you want a certain dosage. This helped me find the right dilution I needed as an individual and it may be of some use to someone.

 

For instance, if you want 293mg of Lamotrigine from a solution of 300mg of Lamotrigine in water, you can get that by diluting 300mg of Lamotrigine in 60ml of water and removing 1.4ml of that solution. This gives you exactly 293mg. You can also get that by diluting 300mg of Lamotrigine in 34ml of water and removing 0.8ml from that. This will give you approximately 293mg (relatively more precisely 292.94mg). Both these variations might make you feel different.

 

To compute different possible variations all you have to do is write is voltotake(300,293) and it will compute variations of how many ml of water you have to take and how many ml of water you have to remove to get 293mg from 300mg of Lamotrigine (or whatever drug) dissolved in water (or whatever solvent).

 

An example has been attached as a picture.

 

I wrote this keeping in mind that the graduation on my pipette is 0.1ml. So, I can’t remove 11.84ml of water but I can remove 11.8ml or 11.9ml.

 

You can run the code on this page. Just copy and paste the code below and click on 'Run'  (remove any preexisting code from the page before you run it):

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def voltotake(med_wt,med_needed,max_vol=120,approx=0.008):
    
    print('Precise Values:')
    
    for vol_take in range(1,max_vol+1):
        conc, med_rmv = med_wt/vol_take, med_wt - med_needed
        vol_rmv = med_rmv/conc
        if abs(round(vol_rmv,1) - round(vol_rmv,3))==0:
            med_act_wt = med_wt - (round(vol_rmv,1)*conc)
            print('volume_to_take:', vol_take, 'volume_to_remove:', round(vol_rmv,1), 'consumption_weight:', med_act_wt)
    
    print('\nApproximate Values:')
    
    for vol_take in range(1,max_vol+1):
        conc, med_rmv = med_wt/vol_take, med_wt - med_needed
        vol_rmv = med_rmv/conc
        if 0.0001<=abs(round(vol_rmv,1)-round(vol_rmv,3))<=approx:
            med_act_wt = med_wt - round(vol_rmv,1)*conc
            print('volume_to_take:', vol_take, 'volume_to_remove:', round(vol_rmv,1), 'actual_consumption_weight:', med_act_wt)
            
voltotake(300,293)

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Note - Let me explain some things in a way which makes using this as easy as possible for a person who has not learnt Python or programming yet:

 

i.) If you want to take 3.36mg from a 5mg pill of any drug, all you have to do is replace voltotake(300,293) with voltotake(5,3.36) in the above code. Similarly, if you want 6.2 mg from a pill of 7.5mg of any drug, all you have to do is replace voltotake(300,293) with voltotake(7.5,6.2). 

 

Basically, the format is:

 

voltotake(weight of medicine you are diluting, weight of medicine you want)

 

ii.) By default, the maximum volume of water you can take is set to 120. If you want to increase the limit of the water you take from 120 to 200, simply add a third value specifying the increased limit like so: voltotake(5,3.36, max_vol = 200).

 

iii.) Changing the degree of approximation: The code gives you various combinations of “water to take and water to remove” to get either precisely the amount of drug you want or approximately close to the amount of drug you want. You can change the degree of this approximation if you wish. More precise values will give you less combinations and less precise values will give you more combinations.

 

While the code is good enough as it is (for me), if you want to change the degree of approximation, you can use the approx parameter (higher the value of approx, lower the precision; by default it is set to 0.008):

 

For example, voltotake(5,3.36, approx = 0.015).   

 

You can use both the max_vol and approx parameters together if you wish. For ex: voltotake(300, 293, max_vol = 150, approx = 0.1)

 

iv.) If there are no approximate values to print but only precise values, it will show nothing under ‘Approximate Values’. Similarly, if there are no precise values to print, only approximate values, it will show nothing under ‘Precise Values’.

 

v.) I’m sure the code can be written much better or more efficiently, but it works well enough for my purposes and I assume it should for most others.

[Altostrata]

Welcome, @ThroughTheForceField

 

Yes, there are calculations for dilutions. Thank you for giving such a lot of thought to this.

 

The members here probably mostly will not be able to run code. Might you make an app for them?

 

Please shorten your signature to 12 lines summarizing your drug history in a simple format that's easy to understand at a glance. This helps the staff understand it.

[ThroughTheForceField]

1 hour ago, Altostrata said:

Yes, there are calculations for dilutions. Thank you for giving such a lot of thought to this.

 

The members here probably mostly will not be able to run code. Might you make an app for them?

 

It's just a matter of copy-pasting already written code in the link provided and clicking 'Run' . There's no need to write anything extra except put in the values of how much drug you're diluting and how much you want (pretty much like an app). It's pretty simple .

 

But fair enough. Even that might be difficult for some and an app might be a lot more intuitive and easier to use. I haven't gotten to app-building yet, but I'll see if I can take someone's help to build one.

 

 

[ThroughTheForceField]

Okay, so this is how it goes. My original issues are a low mood, obsessive compulsive symptoms and a lot of traumatic experiences/family related issues (to put it mildly). As mentioned, I was prescribed Lamotrigine, Mirtazapine and Escitalopram to deal with this. I have been on these three drugs since 2015.

 

 

The only drug that actually works to do what needs to be done is the Escitalopram. If it were an ideal drug, all it would do is make my mood normal and eliminate obsessive compulsive symptoms entirely. It wouldn't do anything else and I also would not need the other two pills I take. Unfortunately, it isn't an ideal drug and it causes 3 prominent side effects for me (which make me need the Lamotrigine and Mirtazapine):

 

 

i.) Sexual dysfunction (at higher doses): This has been eliminated completely due to my dose being very low. I have luckily never suffered from PSSD even after being on high dose SSRIs in the past.

 

 

ii.) Tremors: My hands and legs shake very badly if I take any SSRI alone. It makes functioning in everyday life miserable. Mirtazapine is the only drug out of the three I’ve tried for tremor reduction that actually completely removes these tremors. The other two were Propranalol and Primidone, both of which worked very poorly.

 

As a side note, the side effects of Mirtazapine are:

 

a.) Vivid dreams: mine are usually quite fun and not a problem. I haven’t had a dreamless night of sleep since 2015 though. Forgot what that even feels like.

 

b.) Sedation: I don’t mind this. It helps me sleep better at night and it puts me to sleep consistently (has been doing so since 2015).

 

c.) Hunger: Not a problem for me. I am not obese, I do not have diabetes and I eat a bit lesser than I should be ordinarily. Mirtazapine actually helps me eat.

 

However, Mirtazapine has no effect on my mood whatsoever. It’s supposed to be an antidepressant but it does not elevate my mood like SSRIs too. Mood-wise, it’s pretty much a placebo for me.

 

 

iii.) Excessive mood elevation: I am very sensitive to any SSRI. I’ve tried 3 SSRIs and 1 SNRI and they all do the same thing to me. For a lot of people SSRIs do nothing to elevate their mood. I’m not one of them. I actually get high on them: my mood feels significantly brighter, I feel happier and more positive, I feel sharper and more in control of my mind and body, obsessive compulsive symptoms reduce significantly (even go away completely if the high is strong) and naturally I feel more confident. Even if I don’t take an SSRI for a long period of time (which would land me in depression whether due to withdrawal or otherwise), taking one pill at night after that creates a discernible change the very next day.

 

 

However, it’s not like the high stops at some point. If I continue taking Escitalopram (or any SSRI/SNRI alone without any other drug to cap that mood elevation), it ascends into dangerous overconfidence, reckless behaviour and finally into becoming delusional. I went through that a long time ago and never want to experience it again. I never take Escitalopram or any SSRI alone. 5mg of Escitalopram is a dose which does nothing for most people. But even 3.4mg provides me with significant (and discernible) mood elevation.

 

 

Psychiatrists call this sort of a response “antidepressant induced mania” and you might very well know what “diagnosis” they stamp a person with when this happens. I simply refuse to be psychiatrically categorised with DSM junk anymore (it has brought nothing but brutal gaslighting, disease-mongering and harassment into my life) and I just say my issues like they are. Nothing like this happened prior to taking SSRIs and none of this exists without them. To me, it is just a high like a street drug might get someone high.

 

This is where the Lamotrigine (or any “mood stabiliser”) comes in. Lamotrigine caps this mood elevation and taking Sufficient Lamotrigine + Escitalopram results in a normal, grounded mood.

 

 

2015 is when I started taking Lamotrigine. I was to take this drug alongside the Escitalopram. By itself, Lamotrigine does nothing to alleviate my low mood. I need the Escitalopram for that.

 

My shrink got me upto 250mg Lamotrigine slowly. But this was not a sufficient amount for me as it was improperly capping the SSRI high. I’d keep going high, normal and low randomly. So, he asked me to increase it to 300mg. This worked to completely remove the mood variations and I was fine. I was on this dose everyday till the beginning of 2022 along with 7.5mg Mirtazapine and 5mg Escitalopram.

 

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Sometime in late 2021 or early 2022 I decided to taper down to the lowest possible dose of all 3 meds to minimise side-effects, dependence and make tapering easier when the time comes whilst still keeping in mind that they should still work as intended.

 

 

I don’t remember when I started. All I know is I was on 277.5mg of Lamotrigine on 11-Mar-2022 and I have accurate data only from that date because I started making notes on dosages, dilutions and associated effects only from that date. I do not remember when I started going down there or whether I went down in one shot or tapered down slowly.

 

 

Anyway, from 11-Mar-2022 to 26-Jun-22 I was on 277.5mg Lamotrigine. All through this while I was cycling through highs, normal mood and lows because this dose was not enough for me. Also, because I forgot about my earlier experiences in 2015 of cycling mood, I kept changing the Escitalopram between 0mg, 2.5mg, 5mg, 7.5mg throughout to deal with these mood changes (lower doses if I felt high, higher doses if I felt low). I can see why I did that only in retrospect. Despite these issues, I went down the Lamotrigine regardless.

 

 

From 27-Jun-22 to 2-Jul-22 I was on 270mg Lamotrigine. Then, I went down further. But a big jump of 20mg this time. On 3-Jul-22 and 4-Jul-22 I was on 250mg.

 

 

3-Jul-22 was fine, but on 4-Jul-22, I ended up having severe obsessive compulsive symptoms, way worse than what I naturally have. On 5-Jul-22 and 6-Jul-22, I stayed on 250mg Lamotrigine and the horrible obsessive compulsive symptoms continued. I couldn’t take it any longer and I went back up to 277.5mg on 7-Jul-22 and the obsessive compulsive symptoms disappeared. From this point on I kept increasing the Lamotrigine to where I am now at 291mg. 290mg seems to be around the threshold dose at which the excessive mood elevation from the SSRI is totally capped. Below that leads to mood cycling. But I’m not entirely sure yet. All I know is at 300mg it didn’t happen at all.

 

 

Also, tapering down quick from 7.5mg to 6.5mg to 5.5mg Mirtazapine over a period of just 2 days didn’t really cause any adverse effects. What did affect me was using 15ml water to dilute 7.5mg mirtazapine. Taking 5.5mg from that solution puts me into a strong stupor and a long 12-hr sleep which I feel sleepy after even after I wake up. Switching to 30ml of water fixed that issue. I also noticed the tremors coming back at 5.5mg so I bumped up Mirtaz to 6.2mg again.

 

 

Next, taking a full 5mg dose of Escitalopram causes a feeling of psychological stiffness where it feels both sort of “physically stiff” in my mind and also makes my mind feel stuck. Thoughts don’t flow smoothly. Reducing the Escitalopram to 3.2-3.4mg levels has greatly reduced this feeling. However, I’m still trying to figure out whether the Lamotrigine also has something to do with this.

 

 

So, here I am now. 291mg Lamotrigine, 6.2mg Mirtazapine and 3.25mg Escitalopram which I get from diluting 300mg, 7.5mg, 5mg of those drugs in 50ml, 30ml and 34ml water respectively. There are still some things to figure out, but it seems to be okay for the moment. ‘

 

 

My questions are these. Is the Lamotrigine going to cause any brain damage long term? I do not have some of the more serious cognitive issues some people talk about (short term memory loss etc.) when taking it. I’m fine for the most part. But the obsessive compulsive symptoms that came up when I went down to 250mg really scared me. Have you seen this happen to others before? I went to a neurologist just a few months back and took an MRI (not due to the meds but because I wanted one for certain reasons). It showed no structural issues (functional and chemical is obviously a separate thing) in my brain. The neurologist told me to just keep taking my combo since I’m stable.

 

 

What kind of knowledge base on this drug do you have from all the members here on the long term use of this drug? Is Lamotrigine safe to take for say, 10 more years? If ever the day comes to taper off, will I be able to? If I start facing any issues after a while, and I want to switch to another drug, how will I go off the Lamotrigine to start that? Will it be simultaneously tapering from Lamotrigine and increasing the second drug next to each other?

[littlebird]

That code is really cool! Thank you for sharing that. Welcome to SA, hope you're doing all right today!

[ThroughTheForceField]

I can't edit posts after an hour, so in case it's confusing, under the Mirtazapine side effects I wrote:

 

"However, Mirtazapine has no effect on my mood whatsoever. It’s supposed to be an antidepressant but it does not elevate my mood like SSRIs too*. Mood-wise, it’s pretty much a placebo for me."

 

*I meant: "However, Mirtazapine has no effect on my mood whatsoever. It’s supposed to be an antidepressant but it does not elevate my mood like SSRIs do. Mood-wise, it’s pretty much a placebo for me."

[ThroughTheForceField]

I also wanted to ask for future purposes. I've already had dental anesthesia on these drugs and they have not caused me any problems. But in the future, for any surgery, if I need to have regional or general anesthesia or any other sort of sedation, what kind of interactions can occur with it? Have you compiled a unified body of information (even a specific pinned topic on any of the sub-forums) about potentially hazardous reactions between psych drugs and different types of anesthesia?

 

Also, what are some commonly used drugs that I should avoid taking when on these pills?

 

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As an aside, if someone wants a neater/better version of the code given in my first post and a simpler explanation, see this and this.

[Altostrata]

We provide peer support for tapering and withdrawal syndrome. What are your plans to taper your drugs? How may we help you?

[ThroughTheForceField]

Hello. Though I would love to eventually taper off, it's almost impossible given my current situation. I wouldn't be able to function or study, which is an absolute necessity at this point in my life. Only once I'm in a more secure place in my life, can I attempt to do that. I have tapered down to doses as much as possible for the time being. Mostly I wanted to know if I will get irreparably botched if I take Lamotrigine for 5 or so more years because the withdrawal obsessive-compulsive symptoms when I reduced it scared me and also if such symptoms are expected.

 

I really like this forum and I am thoroughly impressed at what people here have managed to achieve. It is a great resource. I apologise if my question is inappropriate and I'm wasting the invaluable time of the people here. I did read this thread. Maybe such a discussion is more suited for that thread rather than this intro thread which also aims to also be used as a form of case history and research when it comes to tapering off (it is for that purpose and others' information too that I've written a long post regarding my personal experiences with these drugs and how they affect me).

[Altostrata]

Thank you. Yes, you might add your code routine to the Tips for Tapering Lamotrigine topic.

 

18 hours ago, ThroughTheForceField said:

Mostly I wanted to know if I will get irreparably botched if I take Lamotrigine for 5 or so more years because the withdrawal obsessive-compulsive symptoms when I reduced it scared me and also if such symptoms are expected.

 

Such withdrawal symptoms are expected if you taper too fast. They do not reveal an underlying psychiatric disorder.

 

Please let us know when you would like to taper a psychiatric drug.

[Shep]

@ThroughTheForceField I received your PM but am going to post here in your thread, since you're asking the same question you've already asked in your thread - is it safe to continue to take lamotrigine long term (for 5 years)? 

 

I noticed this in your opening post from February: 

 

On 2/5/2023 at 9:06 PM, ThroughTheForceField said:

So, here I am now. 291mg Lamotrigine, 6.2mg Mirtazapine and 3.25mg Escitalopram which I get from diluting 300mg, 7.5mg, 5mg of those drugs in 50ml, 30ml and 34ml water respectively. There are still some things to figure out, but it seems to be okay for the moment. ‘

 

 

My questions are these. Is the Lamotrigine going to cause any brain damage long term? I do not have some of the more serious cognitive issues some people talk about (short term memory loss etc.) when taking it. I’m fine for the most part. But the obsessive compulsive symptoms that came up when I went down to 250mg really scared me. Have you seen this happen to others before?

 

My guess is reducing the lamotrigine and mirtazapine may have unmasked some of the alerting side effects of the escitalopram. 

 

It's possible that the way you're reducing your drugs are causing the obsessive compulsive symptoms. 

Taking multiple psych drugs? Which drug to taper first?

 

Even if you had obsessive thoughts prior to being drugged, withdrawal, especially the way you've been doing it, may make it worse. You may need to seek out non-drug methods of handling difficult and disturbing thinking patterns (mindfulness, CBT, etc. can be helpful for many people). Dietary changes can also be helpful for many people. 

 

Again, let us know if you wish to taper and we can help you set up a game plan for coming off. If so, please set up a signature:

 

How to Summarize Your Drug History in Your Signature