Holly H - Lamictal first or Trazodone? Plus therapy advice

[HollyH]

Hello all. I’ve been reading this site for at least 6 months, maybe more – learned about it from Beyond Meds, which I’ve followed for years. I’m so appreciative for the existence of both sites. Both confirm my unpleasant experiences with psychotropic medications—experiences that were dismissed by psychiatrists as part of my “illness”— and the difficulties of going off them.

 

I first started taking meds when I was 35, and have now been taking psychotropic medication for 22 years. How did I get here? Never the happiest person and with what I now recognize as a history of childhood trauma, I had some nasty depression on and off from around the age of 28 to 31. While I got past the worst without meds, I continued with a kind of low grade depression.  In 1991, my psychotherapist referred me, after much nagging on my part, to a psychiatrist to get a prescription for antidepressants. But the psychiatrist turned out to be old school and refused to prescribe meds; he actually said that I needed to deal with my emotions. (No really, it did happen!)

 

But I was determined to feel "better," and to not feel any negative emotions. So I found someone who would prescribe meds. I started with a diagnosis of atypical depression and was prescribed SSRI antidepressants, but was eventually slotted into what someone on this site referred to as the “waste basket diagnosis,” bipolar II, due to my symptoms of irritability. It’s clear to me now, of course, that if taking a drug makes you irritable, you are experiencing a side-effect, not a sign of an underlying disorder.  Unfortunately, with the bipolar II diagnosis, I was prescribed mood stabilizers along with antidepressants. I got worse, not better. It was a stealth process, though, with me slowly becoming more depressed, plus agitated, and losing the small measure of self-esteem that I had. These drugs took me from being somewhat troubled but engaged in life to the belief that I was mentally ill and had to take medications for the rest of my life. While feeling worse than ever.

 

I did do some tapering, begining in 2006, which reduced my medication load about 50%. Now I am 57, no longer young, not married. I do work for a non-profit that does good work, but it’s taxing. I have some good friends, not much family left. I am trying to get off the medications, slowly, but of course it’s gotten harder as the dosages have gone down. My psychiatrist was cooperating with prescribing the appropriate Lamictal dosages for tapering, but the 25 mg pills are absurdly expensive and my health insurance provider will no longer pay for them. So I’ve had to go with the larger, 150 mg pills and cut them up. I take the brand, not the generic, because I'm extremely sensitive to dose fluctuations. Have been from the beginning on this drug.

 

So my questions: I am tapering off Lamictal and Trazodone. I have read here that one should taper the most activating drug first, but I’m not sure how that applies with these two drugs. Lamictal is said to be sedating, but my psychiatrist says that in his experience it is a bit activating. Trazodone is known to  be a sedating drug, which is why so many use it for sleep. But I’ve read (here, I think) that it can create an unpleasant kick back and actually can disrupt sleep for some. I take them together at night, so it’s hard for me to sort out whether they are both sedating or one is sedating and overcoming the stimulant properties of the other. I do tend to wake up in a negative mood, and have trouble getting up in the morning, if that means anything. My mood is always best late in the day.

 

Second question: I have slowly figured out that I had a traumatic early childhood, but I don’t remember much, and what family I have left is in denial. I have tried some trauma therapies, but I have always experienced an unpleasant backlash effect. I now want to try something called Somatic Experiencing, which is based on the theories of Peter Levine.  It sounds like it would be gentle enough not to create the sort of “backlash” I’ve gotten from other types of therapies. Has anyone had any experience with doing this kind of work while on meds/tapering off?

 

Thank you for your response. And thank you all for talking about your journeys here; it’s inspiring!

 

 

 

 

 

[mammaP]

Hi Holly. welcome to SA.  You've made a few changes this year, up and down a bit and finding it

more difficult at the moment. That tells us that your nervous system is starting to struggle and 

you need to hold everything for a while to allow it to settle down. It might take a few weeks, or a

few months, no-one can tell but it will settle down eventually, then you can start tapering again.

We usually advise tapering one at a time. When tapering more than one it is difficult to know 

which cut caused a problem.  

 

You could ask a compounding pharmacy to make the lamictal into a liquid for you. I'm not sure

how that works with insurance but it is much easier to taper and accurate. If you can't get it 

compounded then you could make your own liquid. Here is a topic on how to do that. 

 

http://survivingantidepressants.org/index.php?/topic/2693-how-to-make-a-liquid-from-tablets-or-capsules/

 

Once you have stabilised I think I would taper the trazodone first, based on what I've read here. 

 

We have some interesting threads on therapy and non drug ways to deal with emotional problems.

http://survivingantidepressants.org/index.php?/topic/1112-non-drug-techniques-to-cope-with-emotional-symptoms/

 

Thank you for including your history in your signature, it is very helpful .

[Rhiannon]

Just a couple thoughts before I head to bed: I'm tapering Lamictal too (well the generic, which works ok for me) and I dissolve mine in water.

 

Back when I was still dry cutting pills I found that it's very difficult to get good precise doses without at least using a milligram scale. Are you using a scale, or "eyeballing"? At lower doses eyeballing introduces too much variability, in my opinion based on my own experience.

 

Dissolving in water is great, I reduce by 1 mg at a time right now and when I need to I will be able to go to 1/2 mg reductions.

 

I agree, probably trazodone first. You can do alternating tapers, as you know, taper one for a while, then the other, so they both come down over time.

 

Also, I haven't done the Levine work so I can't speak to that, but I've done really well with EMDR as a technique for working on trauma issues. And have definitely found that somatic type therapies are much more helpful with PTSD and trauma work than stuff like CBT or talk therapy, although those do have their place.

[HollyH]

Thanks, mammaP and Rhi for your responses. What a relief it is to actually communicate with someone about this! I’ve been trying to deal with the medication issues on my own, because I don’t know anyone else who has ever tried to go off. But I can see that doing it alone is not going to work - I need other people to point things out to me. Like that I should hold for awhile. Because after years of mostly thinking about tapering off and not doing it, now I can barely hold myself back!

 

Definitely a compounding pharmacy or a liquid formula sounds like the thing to do. I will check these out while I hold. I think with the liquid I will have to practice first anyway – precise measurement is not my forte.

 

Rhi, I’m glad you found EMDR helpful. I may look into that as well. I was leary of it for awhile, because well, it's weird. But the psyche is weird, so why be surprised if what helps us looks a little strange!

 

Bless you both.

 

Holly

[Altostrata]

Welcome, Holly.

 

When you're taking too much Lamictal for your nervous system, it can be activating. Your psychiatrist's remark indicates he's been overdosing lamotrigine throughout his career.

 

Why are you taking trazodone?

 

What's your symptom pattern throughout the day, relative to when you take your drugs? You will need to keep notes on paper for this.

 

Are you taking any other drugs? Please put ALL the drugs you take in the Drug Interactions Checker http://www.drugs.com/drug_interactions.html and post the results in this topic. This will help sort out which to taper first.

[HollyH]

Hi Altostrata,

 

I'm taking just Lamictal 77.5 mg. and Trazodone 104 mg. I also take Calcium, a multivitamin, 400 mg vitamin E, and turmeric. No fish oil at the moment as I had some trouble with a high EPA brand. (My plan is to start again with one with more balanced EPA/DHA)

 

Here's what the Drug Interactions Checker says for using Trazodone and Lamictal together:  may increase side effects such as dizziness, drowsiness, and difficulty concentrating. Some people may also experience some impairment in thinking and judgment. (Sounds true!). You should avoid or limit the use of alcohol while being treated with these medications. Avoid driving or operating hazardous machinery until you know how the medications affect you.

 

Trazodone was originally prescribed to help me sleep. I just found my notes on it (I have some journals where I chronicled my moods and medication changes) - in 1998 the psychiatrist started me on time-release Effexor and Neurontin (after tapering me rather quickly off of Paxil, Lithium, and 5HTP), and it was making me anxious. So the Trazodone was added to help me sleep, and survived as other meds were stopped and started. i did increase the dose some when I dropped the Nortriptyline back in 2006. 

 

I will monitor myself over the next week to see how my moods go through the day; I take the meds together at night. I'm about to go on a short vacation so moods are somewhat improved!

 

Holly

 

 

 

 

 

[Altostrata]

It sounds like trazodone was added because Effexor was disturbing your sleep. This is a common side effect of Effexor.

 

Why was Lamictal added later?

[HollyH]

Well, I found some more notes about my medication use in 1998-2000, and it  turns out my memory did not serve me as well as I thought. I was off and on so many drugs during that time--really upsetting to read it.  So i changed my signature a bit. Can't add more meds to it cause I've hit my word limit!.

 

Trazodone appears to have been prescribed before Effexor, but I had been taking other stimulating medications/supplements right before the Effexor, including Paxil, Ritalin, SAM-e, and 5 HTP, so I'm sure one or more of them was the reason I needed something to sleep.  I think Neurontin, my very first mood stablizer, actually wound me up as well. There were other sedating drugs at various points during those 2 years - Lithium, Buspar, Xanax, Klonopin. I alternated the last two with the Trazodone initially, can't explain why that was the case. By 2000, i was no longer taking any SSRIs or benzos, but Trazodone was firmly in place.

 

Lamictal was added in 2003 because it was supposed to have both mood-stabllizing and anti-depressant properties. From 2003-2006 I took it with Nortriptyline and Trazodone at night. I'm not sure whether this combo actually helped with my moods, but they weren't too bad and I slept okay.

[Altostrata]

Hmmm, I might hold reducing the lamotrigine and concentrate on getting off trazodone.

 

How are you doing now?

[HollyH]

Hi Alto,

Sorry for the slow response-I was away for the weekend and had no access to the Internet.

 

Low-level agitation is something I experience somewhat regularly.  It increases whenever I cut the Trazodone or the Lamictal, as it did right after my most recent cut of the Trazodone to 104. I feel the agitation in my chest when that happens, an angry ball. It decreases after a few weeks, but has not as yet. I am doing okay sleepwise; cutting the Trazodone to 104 mg hasn't seemed to effect my sleep at all.

 

One thing I am struggling with is alcohol. Actually, just wine. If I'm agitated and uncomfortable,  a glass of wine seems like a nice idea. It's very difficult for me to drink just one, though.  Maybe I've just developed alcoholic tendencies, but it feels like the meds are connected. I don't have this issue with beer, or hard liquor;  I can drink one and I don't want more. 

[Petunia]

Hi Holly,

It sounds like you are doing well, its fairly normal for it to take a few weeks for increased symptoms to subside after a cut.

 

A lot of people mention that these drugs increase their craving for alcohol, so you are not alone there.  Many people do better, and have an easier time with withdrawal if they don't drink alcohol, it seems to make symptoms worse the next day.

 

Petu.

[Altostrata]

Holly, it's clear that low-level agitation is a withdrawal symptom for you. Please heed the warning and go very carefully in reducing your drugs -- one at a time, very systmatically, keep notes.

[EternalOptimist]

Hi,

I did use Somatic Experiencing earlier this year and in early w/d. It did help some. Found a therapist who did house calls. Was lucky. It was mostly helpful if she just held me and I could cry, get out the pent up grief and fear as I tend to stuff it. Felt strange tho and was out of pocket. I like the approach and am reconsidering Since I stopped it.

. I then decided to work with homeopathic MD psychiatrist with a non drug approach by FaceTime and phone. Not sure how that is working but is quite costly so I am now wondering what to do. Neither seemed to understand drug w/d nor CFS. I have anxiety disorder and was trying to address that on its own. Personally, I feel I suffer from separation anxiety and abandonment issues. I do Tapping for these in the middle of the night when I can't sleep and my mind ruminates .

[HollyH]

Petu, Altostrata, thank you for your responses. I did not post anything this past week because I had such a crazy week – mood changes, all over the map. It started last Saturday, (although I didn’t realize it at the time) after a walk in the country that was fairly aerobic. I almost always get an endorphin lift from aerobic exercise, but in this case it was a bigger lift than usual and I felt better than I can remember in ages. I am usually a repressed person and hold my tongue about a lot of things, but at dinner that evening with a friend I could not contain myself in expressing strong opinions about an issue in her family, coincidently, the way they were dealing with a child diagnosed with ADHD and dyslexia. (No meds yet, thankfully.) I won’t go into it because that’s not the point of the story – just that I was very different than my normal self.

 

In the middle of the night Saturday, though, I was having strange dreams and feeling very upset and adamant about something, but could not remember what by the time I woke up. Sunday I was a bit meh, in terms of mood.  I read some posts here by Againstallodds that night and those got me agitated; I actually started doing something she was describing—becoming agitated just from having a difficult thought. Or maybe I always do that and never recognized it. (Of course, I was empathizing with her and wanting to get my hands on the folks that put her on all of those meds!) By Monday morning I was depressed and wondering what’s the point of living. Since then I’ve gone from that depressed mood, to agitated, to anxious, to fits of optimism, to anger. I often express whatever “this” is through the body –tightness and a wringing kind of feeling in my chest, my abdomen feeling like it’s a big rubber ball twisting inside me. That was heightened all week.

Today I’m feeling more energetic than usual, but in a focused way, so I’m actually getting some things done. The underlying feeling keeps changing – somewhat optimistic, then kind of wrung out.

 

I bought myself a little notebook so I can start chonicling this stuff in real time (and meds, and supplements, etc.) . Otherwise it's very hard to know what I'm reacting to. or if it's just withdrawal, or both. I also  bought a scale-the one recommended on the tapering thread - and will start using it today. Fortunately, some of these mood swings come with a desire to straighten things up and be more methodical.

[HollyH]

Hi Eternal Optimst,

 

Did you find the Somatic Experiencing therapist through their Trauma Healing website? It does sound kind of strange from what I've read. But if it works, that's the important thing! There are lots of SE practioners where I live; I'm just trying to get up the nerve to try it out.

 

Why did you choose to see the homeopathic psychiatrist? What is he/she doing for you?

[Rhiannon]

Holly, you need to hold for a while, I think you can see that.  It's also a good idea to get better control of your dosing. The scale will help with that.  Sounds like you're on track--use the scale to get precise and repeatable doses, take them consistently with no changes. 

 

I think you should think in terms of holding, no more changes, for a couple of months, and use that time to really get control of your dosing.

 

You may even want to experiment with dissolving your tablets--using the liquid sounds a bit daunting to most folks at first but then once they do it they usually say "it's so easy!" Personally I find it to be less fuss than the scale and the dry cutting with all the math and the carefully shaving down bits of tablet bit by bit (I used an emory board when I was still dry cutting).

 

Anyway, this is a good time to experiment and figure out what's going to work for you while tapering, without actually reducing your doses, for a while, to give your nervous system time to settle down and rearrange and remodel itself a bit to adapt to the reductions you have already made. Once you're feeling really solid you can start with a more controlled slow taper. It's very do-able if you go slow.

[HollyH]

Hi Rhi,

 

I do see that I need to hold for awhile. I got acquainted with my new scale yesterday and weighed out my Lamictal doses for the next week. You're right - It really is a nuisance dealing with all of the math, and the tiny pieces of the pill! I'll see how my patience holds out with that. The Trazodone is much easier to work with than the Lamictal, since the pills are round instead of the Lamictal "shield."

 

I had thought maybe I could use the 5 mg chewable Lamictal generic to top up the number of mgs when needed. Cut them in half for 2.5 mg, use 1 1/2 of them for 7.5 mg. I tried this Saturday night, and felt rather bad yesterday. Depressed, lethargic, but with intense pressure in my chest.  It's clear I just don't respond well to even a little bit of the generic. I had to cut off a teeny piece of my 150 pill, which is the brand, and take that late in the afternoon.

 

I did some reading in the  supplements section on the board yesterday, as well as some people's threads, and I have to say I found it kind of overwhelming. So many people struggling. I'm afraid of getting worse as I reduce the meds because I've cut too much or taken some supplement I shouldn't  have.  I did discover something I did not know, though - that I sometimes experience this thing called "depersonalization." I was always afraid to find out what that was; now I know.

 

 

I think I need to go watch some dumb television show now and not think about this for a bit!

 

Holly

[HollyH]

Been awhile, although lots going on. I’ve vowed to post more; don’t know why it’s so hard sometimes. Actually, I do know why-I’m terrible at asking for help, even on the Internet! Since I last posted, had seemed like my state of mind had improved somewhat. Lots of ups and downs, but some actual optimism at times, which is not characteristic. My thinking improved some, so was able to accomplish more at work. (Not that I get any appreciation from my narcissistic boss, who takes the credit when I do well!) I felt that maybe there are things that I can actually do to improve my life. When I felt bad, I could actually tell myself – this is a mood, not reality.

 

Two weeks ago, I made a mistake and took my usual 104 mg of Trazodone, and then another 100. I knew I might be doing this but just couldn’t remember taking the first 104. The next work day was going to be a stressful one so I didn’t want to risk not taking it.  I woke up at my usual time and while feeling crappy, did not feel like I could sleep more.  It was soon clear that I had indeed doubled the dose, because after turning on the television to check the weather, I couldn’t remember how to turn it off! I muddled through the work day by the skin of my teeth. My mood since then has been somewhat alarming, and has included an upgrade of my usual level of anger to rage. For example, I was enraged at a member of a committee I work with after she did something that I felt made me look bad in front of my bosses.  I felt like I could lose control and actually hurt this person. My psychotherapist was not alarmed by this rage at all; said this is how people who don’t stuff their emotions actually feel sometimes. So maybe it’s normal, but I do wonder if the extra Trazodone, even though just for that one night, scrambled my psyche at bit. I’m curious if anyone has an opinion on whether one double dose of Trazodone (200 mg instead of 104) could cause such irrational anger 7 days later (and still feeling some of it).

 

BTW, the day of the Trazodone double dose, two weeks ago, I bought and drank an entire bottle of white wine! Could not believe I had done that. That's it for me and wine. I've had 6 or 7 beers total over the last two weeks, which is not a huge amount (and no wine), but I do feel an actual craving today. I really hate this - I was never like this. It was rare for me to have more than 2 drinks in a night, and only on weekends.

[mammaP]

Hi Holly, good to see that you had been improving but I'm sorry that you are feeling rotten again.

I made a similar mistake once, and took a whole capsule of 75mg of effexor instead of the one

with just  4 beads in it,  400 beads instead of 4  . I felt pretty rough for a couple of weeks I think

before things started to settle down again. Don't be worried about being angry, it is a normal emotion

in reaction to a situation and you dealt with it without the violence that you felt like inflicting. I think

everyone feels like that sometimes but control it so no-one knows about it.