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Lamictal and anxiety and SSRIs oh my!

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Posted

Hi Folks,

I would like to post about my Lamictal experience and see if anyone has experienced similar issues.

For about two years I had been taking 15 mg of Celexa, and 200 mg of Lamictal. I had been taking the Celexa for a while before starting the Lamictal. This combination worked for the most part, except my pdoc and I thought we could do better; I was still experiencing rare but severe mood swings, sometimes down into a near-suicidal depression.

We tried various drugs, including Geodon and Lithium. The Geodon totally knocked me out, and I wasn't happy with the Lithium. In addition, my pdoc had me cut off the Celexa cold-turkey, which was not a very good idea (which I know now).

At this point, I decided to stop taking any meds to see how I could function without. I had been on many meds over a period of several years, and didn't really remember what my baseline was. I let my pdoc know of my plans and tapered down to nothing over a period of several weeks.

Long story short, I realize that I needed meds. My pdoc suggested that I go back on the Lamictal without the Celexa to see how that would work.

It was a f**king living hell.

Started out okay, but then I noticed that I seemed to be more anxious and nervous. Nothing really bad at first, but steadily getting worse. I started to get panic attacks, particularly related to fear of confinement. I couldn't sleep with my blanket on my upper body because I felt like I was suffocating. My cat, who would curl up to me when I slept, provoked panic when up against my leg because just the (irrational) thought of not being able to move my leg made me panic. I couldn't sleep anywhere near my wife, and started to sleep on the couch in my study. I typed documents on the computer double-spaced because in single-space mode, the text was too crowded together and it made me nervous (really!)

Things continued to get worse. I could be doing something innocuous like reading my email and feel waves of adrenaline pass over me. I started to get restless leg syndrome and started panicking about that. I felt like I was being punched in the stomach repeatedly. I knew logically that everything that was happening was just a panic response but it was overwhelming. I practiced my CBT techniques, saw two hypno-therapists, an acupuncturist and a massage therapist. I consumed no sugar, caffeine, or alcohol, and exercised regularly. All of these things helped, but the panic always came back shortly after. On top of this, I couldn't sleep well and would awaken drenched in sweat.

I did take Xanax during this period, but it made it hard to stay awake at work. I was falling asleep at my desk and during meetings. And, it didn't really work well.

My wife was an absolute angel during this whole time but I could tell I was wearing her down (and understandably so.)

What I'm trying to say here is that I was pretty miserable :-).

This went on for a month and a half. Every time I increased the Lamictal, things would get worse. I finally insisted that I go back on the Celexa, to at least get back to a point where I was before when things were okay, if not great. A few weeks after starting the Celexa, the panic started to die down. I did have two periods of near-suicidal depression, but things evened out.

To summarize: the Lamictal caused me great problems until I started taking an SSRI in conjunction with it.

I'm now on 20 mg of Celexa, 100 mg of Lamictal, and 750 mg of Trileptal. Things are much better.

As a side note, I have tried a few times to tweak my dosage of the three meds I'm on now. More Lamictal makes me feel confused and gives me dizzy spells, especially when doing things like standing up quickly. 900 mg of Trileptal made me so tired I couldn't function.

- TroyNY

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Posted

My cocktail is a bit different than your's, however I also experienced debilitating anxiety on 200 mg of Lamictal. My pdoc cut it in half and I am now taking 100 mg DID. The anxiety is almost gone now, which indicates that for me, 100 mg Lamictal is all I can handle. I may have to go even lower, depending on how the anxiety goes. "Almost" gone doesn't cut it with me.

It does seem weird. Very few people have reacted this way. One other person I know of here, Synthetic, also had this problem and had to discontinue Lamictal completely.

Interestingly, I am also on Trileptal which I did read increases the level of Lamictal in your system. That might have something to do with it. I will be going higher on the Trileptal. I'm speedy Gonzales, so I will probably be fine with the sedation.

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Posted

i take 300mg of lamictal, among other things, as you can see in my signature. i've never taken it by itself so i don't know what it would do to me if i tried.

however, there was a point where i was on 500mg. on that dose, i did experience a rapid heart beat, and mania like symptoms.

my pdoc brought it back down to 300mg and all is well in the world again.

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Posted

Hmm. Lamictal can be energizing for some people and a little sedating for others. This is the first I recall of such anxiety/fear/panic attacks.

It isn't really documented in the PI sheet, but a number of members report becoming a bit manic after starting Lamictal. I found that my temper was hair triggered for the first month or two, but that faded away (I almost started a fight in the public library with some noisy yayhoos). yikes.

You don't mention specific time periods, but consider that it might take as much as 8 weeks or more after each Lamictal dosage increase for the side effects to moderate. So, it may be some comfort knowing you have a med that is effective, but that you will have a bit of a rough period after each adjustment.

a.m.

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Posted

Thanks everyone for your feedback - much appreciated. I both wanted to see if anyone else had experienced this, and also to provide a "case study" for anyone who might be researching their own side effects on Lamictal.

AirMarshall: Going along with your observation, my pdoc had mentioned that he hadn't really seen this before in his patients; I guess I'm just lucky :-/. I did do some more searching on Usenet and found a few people who had experienced similar side effects but not many.

I did keep a journal over the months I was suffering; I still can't go back and read it because it really hurts to do so. It was invaluable though - if I'm feeling good, I tend to forget on some level how bad things really were, and if I'm feeling bad, I tend to forget that there were times that I was doing okay. I really need to go back to keeping it.

- TroyNY

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Posted

Wow. I have pretty bad anxiety and feel that I have tried everything. I was on Paxil during my pregnancy and did okay, but now that isn't recommended because of possible infant heart problems.

My worst anxiety symptom is a tightening in my throat. My pdoc put me on 25mg of Lamictal and that feeling instantly went away and I thought "THANK GOD SOMETHING FINALLY WORKS!" After going up to 50mg, however, I started to have insomnia and have stomache bloating that was horrible, not to mention a menstrual period from hell. So, my pdoc had me go back down to 25mg and wants me to slowly go up again...I'm not really interested in that. Even the 25mg makes me feel irritable.

Also, I seem to have breakthrough depression and am wondering if she would put me on a mixture of lexapro and lamictal...I just feel like I need something else in combo with the lamictal to feel better.

Any ideas/suggestions?

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Posted

I am on 300 mg. of Lamictal and do experience some bad bouts of anxiety, but they were present before the Lamictal was intoduced. I take Klonopin to keep them at bay.

Tommy

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Posted

The first time I went on Lamictal, I got my first and only full-fledged panic attack. That was a pretty (for me and my weak-ass liver) fast titration. The second time around we started much slower and the anxiety ended up being a postive sort of activation. Unfortunately, I had an allergic reaction so had to d/c. If you want to increase the Lamictal more and are concerned with panic, maybe do it in tiny tiny increments. E.g. 12.5 or even 5 mg (pediatric chewables) at a time...

Good luck,

cache-monkey

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Posted

I'm feeling nervous with the Lamictal too. Ever since I went to 50 I've soared to what must be hypomania (just diagnosed BP II). I think it's because I'm still on Cymbalta and the combination is sending me there. I don't sleep much, I watched the History Channel until 3am the other night and was convinced I could reform all religion after watching one of the shows. I called my pdoc's office and they gave me sleeping pills! What can I take to slow this episode without sending me into depression? I'm also going through Cymbalta Withdrawal HELL! I hate Cymbalta - if I met the people that created it I think I would slap them and I've never hit a person in my life.

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Posted

this is pretty much just wild-ass speculation on my part at this point, but back when i was having some atypical experiences on lamictal titration a friend suggested it may have something to do with NMDA blockade, causing a positive spiral in dopamine levels.

let me explain . . . (and point out i'm not a scientist either)

part of the reason i was taking lamictal was to see if it would slow down glutamate transmission, and thus help relieve some of my OCD symptoms. (i wasn't diagnosed with BP, just OCD, but i had read that lamictal was a glutamate modulating agent - and all that i had been reading on the latest scientific research abstracts on OCD was focusing on glutamate overtransmission) lamictal affects glutamate transmission by blocking Na+ channels - which trigger glutamate firing as well. i'm not sure i noticed any definite changes on lamictal (i only made it up to 75 mg) but i definitely did have a few near-manic moments. a friend suggested that NMDA blockade (NMDA are a type of glutamate receptors) can cause a positive upward spiral in dopamine levels. so [again wild ass speculation] that may be part of the anxiety feelings some people have described.

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Posted

I take Lamictal and Celexa and I started them a month apart but Lamictal was sedating for me. I will say that once the Celexa kicked in my anxiety tapered off quite a bit.

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Posted

Bumping this as my cocktail is / was similar , interesting to read that Lamictal may have caused mania in some people. I felt pretty ok on just celexa ..am kicking myself for ever fucking with it in the first place

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Posted

Generally if you can't find a thread about your topic within the last year or so, it is better to start your own thread than revive a zombie thread. It just confuses people who usually don't realize right away that the discussion took place 5 years ago.

But Lamictal is known to be not a very good choice for controlling mania.

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Posted

Oh. Sorry

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Posted

No biggie, just letting you know.

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Posted

That makes sense :) was just googling topics and found it

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