goonie: advice on tapering sertraline / Zoloft and lamotrigine / Lamictal

[goonie]

Hello all.  I'm 2 months off benzos after 7 years daily use (prescription) and after a hell of a 2.5 year taper.  I've been on sertraline since 2006 starting at 100mg, however, during the benzo taper I got myself down to 37.5mg.  The lamotrigine was added at the end of the benzo taper to help me finally jump off, to prevent seizures, ease my mind, whatever, etc.  I was at 75mg at the beginning of the year and started tapering this month and am now down to 50mg.  I could go into more detail about everything, but basically I'm extremely sensitive to these medicines and I need some advice and support on the best way to get off of the sertraline and lamotrigine, when to start, what method to use, etc.  I'm very familiar with all the different kinds of tapering from just having got off benzos and trying nearly every method in an attempt to find anything that would work out better.

 

Please let me know your thoughts on tapering these final 2 medicines and which to go for first.

 

Thanks guys!

[Fresh]

Hi goonie , welcome to the site.

  

You might do some reading in the Tapering section , specifically:

- Why Taper By 10%

-Taking Multiple Psyche Drugs? Which drug to Taper First?

- Tips for Tapering off Zoloft (Sertraline)

- Tips for Tapering off Lamictal (Lamotrigine)

 

These will answer some of your questions.

 

Best wishes ,  Fresh

[goonie]

Thanks Fresh.  I read and understand the information you provided.  From the "Which to taper first?" portion it looks like sertraline would be the one to attack first (the most activating). 

 

My remaining questions would be:

1)  I'm ~2months off benzos so how long should I wait before starting another taper?

2)  Since I've been on lamotrigine a much shorter time, should I not attempt this one first?

 

 

Thanks so much!

[Altostrata]

Welcome, goonie.

 

What effect has the lamotrigine had?

[goonie]

Altostrata, thanks for responding.  You seem to be the resident expert on here.

 

I was originally put on lamotrigine back in Oct in an attempt to alleviate benzo withdrawal symptoms prevent any seizure activity once off benzos though the chances were low anyway seeing as how slow I tapered.  I ramped up 25mg every two weeks to 75mg.  On each dose increase, I'd feel the flu-like symptoms and then it would level off.  I got off benzos 2 months ago and I believe the lamotrigine did help me quit as it got rid of some of the physical symptoms enough to where I could get out of the bed.  So... after 6 weeks off benzos I began lowering the lamotrigine going down 12.5 weekly.  I got down to 50mg with no major hassle.  I went down 12.5mg again 3 days ago, but the day after I had some strong symptoms, headache, dizziness, burning, muscle tightness.  Not sure if that was benzo related or because of that drop, but I went back to 50mg the next day and it seems things have leveled out a bit.

 

So... that's the lamotrigine story thus far.  I don't know what to do so any advice would be much appreciated.

[Altostrata]

If I were you, I'd hold on tapering the lamotrigine and after a couple of months, start tapering sertraline instead.

 

The lamotrigine is keeping your nervous system from generating even worse withdrawal symptoms.

[goonie]

Gotcha, thanks.  That's what I'll try then.

 

Just out of curiosity in regard to holding off on the lamotrigine taper... is that based on the whole GABA -> Glutamate balancing act?  In other words since lamotrigine blocks glutamate, it'll help keep things steady while the GABA receptors heal up from the benzo use?

[Oceanrat]

Let your nervous system heal for MONTHS, before budging on any SMALL taper. I didn't find this site Til it was to late. I'm currently very bad off.

[Altostrata]

Lamotrigine reduces nerve cell reactivity to glutamate and other excitatory neurohormones. It permits more activity in the regulatory system, of which GABA is a part.

[goonie]

I am 3+ months off of Valium after a horrendous 2.5 year taper.  I am currently on 50mg Lamictal and 37.5mg Sertraline.  I was advised to taper the Sertraline first.  I cut 5% a month ago.  That went okay so a week later I cut 3% more.  I experienced some dizziness/nausea and that was okay.  But now holding at this dose for 2 weeks and the last few days I'm extremely weak, bedridden, sluggish, and some weird breathing problems and palpitations.  Everything has slowed waaay down and I feel really bad and sick.  Is this common?  Does anyone have any advice?  Should I go back to 37.5 or wait it out?

 

Please help!

[LoveandLight]

Don't know if you know or not, but lamictal and sertraline interact with each other.

 

Best wishes!

[Altostrata]

goonie, I moved your new posts here, as they're about your own journey.

 

Do you get these symptoms often or just once?

 

Do you take sertraline and lamotrigine at the same time?

 

Please keep notes of your daily symptom pattern on paper relative to when you take your drugs.

[goonie]

Thank you Altostrata.

 

I've been getting these symptoms daily for the past 5 days or so and it seems to be getting worse.

 

I take the Sertraline once a day usually in the morning with 25mg Lamictal.  Then the other 25mg Lamictal at around 6pm. It seems like the worst of it starts around 3 hours after each Lamictal dose.  Yesterday I tried taking Lamictal at 6am and then Sertraline at 9am to see if that helped anything, but nope.

 

Any thoughts?

[Altostrata]

It sounds like a reaction to lamotrigine. Could be reduction in Zoloft changed some metabolization of lamotrigine. You might hold on tapering Zoloft and reduce your lamotrigine dosage instead.

 

http://www.drugs.com/drug-interactions/lamictal-with-zoloft-1430-848-2057-1348.html

 

See Tips for tapering off Lamictal (lamotrigine)

[goonie]

Ok, so it seems I'm having an adverse reaction to the lamotrigine.  I'm not sure how that happened as I've been taking it for 10 months, but now an hour or so after my dose, I get really sick like I feel I'm gonna die.  It almost feels like I've taken too much of the stuff even though it is the same dose, same bottle, etc.  Got checked out at the doctor, ran some tests, ekg, blood work,etc and nothing showed so he chalked it up to anxiety.  I was taking 25mg 2x (50mg) daily 12 hours apart.  I've now reduced to taking 12.5mg 3x daily (37.5mg) to lessen the blow of taking so much at once.  I've been doing this the last 3 days and that seems to have made things a bit better.  Withdrawal symptoms have been anxiety and some twitching.  I need to get off of this rather quickly, but don't wanna cause major issues in doing so (I understand that is the tricky part).  My question is what is the best way to do this and is it okay to split the doses up even more througout the day?  The doctors I asked said, "just stop taking it".

 

Thanks so much for your help.

[Altostrata]

It sounds like a reaction to lamotrigine. Could be reduction in Zoloft changed some metabolization of lamotrigine. You might hold on tapering Zoloft and reduce your lamotrigine dosage instead.

 

http://www.drugs.com/drug-interactions/lamictal-with-zoloft-1430-848-2057-1348.html

 

See Tips for tapering off Lamictal (lamotrigine)

 

It is okay to split the doses. You are getting withdrawal symptoms from reducing Lamictal. This can get worse. If I were you, I'd taper it slower (see above) until you get to 25mg, hold, and then go back to tapering Zoloft.

[goonie]

Thank you. After trying to taper faster than you recommended I encountered severe withdrawal. I got down to 25, but think I'm gonna have to stay at 37.5 for awhile. I shouldn't have tried to do that, but the breathing was bad. It is better now. However, I'm dosing 12.5mg every 8 hrs. It seems to wear off after 3-4 hours leaving me in interdose withdrawal. Will this clear up as I stay on this dose? I'm listening now, you have my full attention. You were right about it getting worse. Boy did it.

[Altostrata]

What does the "interdose withdrawal" feel like?

[goonie]

Yeah, I'm not sure that's what it is or not, but I get very on edge, head hurts, some burning sensations. Then after I dose it goes away for a bit.

[goonie]

And also I'm in really bad shape. My head hurts so much and everything is burning. I really need some good advice as at times it is almost unbearable.

[Altostrata]

Maybe you might take lamotrigine 3 times a day.

[goonie]

Yes that's what I'm currently doing. Every 8 hours.

[Altostrata]

I don't know what to suggest. Maybe hold at current dosages for a while? With luck, the symptoms will fade.

[goonie]

Would the xr version be of any benefit?

[Altostrata]

Lamotrigine does not come in an XR version.

[goonie]

I mean switching to lamictal xr?

[Altostrata]

There is no Lamictal XR.

 

It occurred to me -- did you find sertraline activating when you were taking it alone?

[goonie]

Lamictal XR:

http://www.rxlist.com/lamictal-xr-drug.htm

 

I don't remember what the sertraline did when I was taking it alone it was so long ago.  I think I just didn't care about stuff as much.

[Altostrata]

I'll be darned. I updated Tips for tapering off Lamictal (lamotrigine) with Lamictal XR info.

 

I don't know if it will help.

 

Do you get the same symptom pattern 3 times a day, at the same interval from when you take lamotrigine?

[goonie]

Yes, I get about the same pattern each time.

 

I'm trying to do my own liquid preparation for this taper.  I saw on your page that lamotrigine is "stable" in water, however, the link to the document is broken.  Can you tell me what "stable" means and repost any references on your page?

[Altostrata]

The link is fixed. "Stable" means combining it with water does not degrade the drug.

[goonie]

The link is still broken.  404 error.

[Altostrata]

I guess GSK removed the file. Read this http://www.uspharmacist.com/content/c/54528/

[goonie]

Thanks Alto.  I'm not sure you can break the XR though, wouldn't that release too much at once?

 

Is there any advantage to using Ora-Plus vs water? 

[Altostrata]

If you break the XR, you get immediate-release lamotrigine. You cannot mix it with water.

 

There's no particular advantage to using Ora-Plus unless you want to imitate a pharmacist.

 

Please read the lamotrigine tapering topic, I updated it.

[goonie]

Hello guys.  I'm off the Lamictal.  It took 2 years and I'm happy to report it actually got a bit easier at the end to where I wasn't feeling any of the cuts at all.  I jumped @ 2.5mg.  It's been about 2 weeks, so who knows, but I haven't felt anything significant in a long time.  I was a bad case after just coming off benzos and trying to taper the Lamictal too soon and too fast.  I used the water titration method recommended here and it worked.  Nice and slow and if any withdrawal symptoms came (mine were all physical with pain, burning, insomnia, twitching), then I held for a couple of weeks.  On average I dropped .5mg every 2 weeks, but at the end I dropped .5mg every week until I jumped at 2.5mg.  Thanks for your support here 2 years ago.  It really helped.

 

I have one more to go (Sertraline), but it'll be next year before I even think about planning how to go about that one.

 

Hope everyone is doing well.