Lamictal Guidance

[NYCMomOf3]

Hi,

I have 3 children (2 girls & 1 boy). My oldest daughter, who just turned 21 recently, has been having some issues lately and decided to go and see a psychiatrist. I thought it would be a good idea for her to talk with someone and perhaps she would begin to feel better about some aspects of her life. Let me preface by saying that she, up to this point, had never been diagnosed with any psycological disorder. She has a full time job and functions quite well. I know that she is sometimes a bit "down" and think that she may suffer from a form of depression.

Last Thursday she had her first visit. Was a standard initial consultation....30 minutes of filing out paperwork....1 hour with the doctor. I happened to be working from home that day so I was home when she came back from the initial visit. She told me that the doctor immediately diagnosed her with Bipolar II and Borderline Personality Disorder and gave her the starter kit for Lamictal.

My first reaction was HOW can someone, after meeting with a patient for 1 hour, make such a diagnosis. She order no medical history (to rule out any physical reasons for the depression), she did not request to speak to her physican, just prescribed Lamictal.

I asked my daughter to wait on taking it until we could do some further research or perhaps get her to see another doctor. My daughter did not wait. She was fine prior to starting the medication but it is now Tuesday and we spent a 7 hours in the ER. She does not have the rash but she has several of the other side effects that, by what I have seen online and in the documentation that came with the kit, state you should seek immediate medical attention. Starting Sunday morning she began to not "feel well". It appears that perhaps she was getting a cold. By the time Monday afternoon rolled around she had the following:

Fever - consistant of about 102 -103

sore throat

cough

headache

dark urine - ER doc says that she has the beginnings of a UTI (also a side effect)

double vision or blurred vision

difficulty driving - she has since stopped

muscle aches

Again, none of these symptoms occured until AFTER beginning the Lamictal. The ER doctor ran all kinds of bloodwork, strep test, rapid flu test and chest X-rays. All came back as negative...except for the UTI.

I asked the doctor if she should stop taking the Lamictal since the symptoms were all "serious" as per the documentation on the drug. I could see the reluctance and he instead put in a call to the "on call" psychiatrists who, not being given the "full story" (just that she had a fever) said that she was to keep taking the Lamictal.

She also went to the original physchiatrist today and the doctor told her the same thing...to keep taking it and that what she was feeling could not be caused by the drugs and that my daughter must be prone to fevers. My daughter told her that it is rare that she even gets sick...which is the truth. She said that she could stop taking it if she liked and then for her to come back in a few weeks and she would give her something else to take.

Those of you with experience with this drug please tell me what you think. What was your experience with being diagnosed or just what you think in general. I am very concerned as she still has a fever of 102 and does not appear to be getting any better.

Many thanks to any who can help or offer any guidance to us.

[Amy10]

This sounds worrying. The speed of the diagnoses, which are both pretty serious, is a bit surprising. At least with myself, a diagnosis of bipolar I took a while. My early symptoms were tentatively diagnosed but it was up in the air for a while until I had a clearcut manic episode. I don't know what the situation is with your daughter. How does she feel about the diagnoses? Does it make sense to her? Do either or both of you feel the symptom cluster of each label fits her personal experience?

I was put on Lamictal in 2004 and it wiped out a deep depression. It made me rather agitated and hypomanic for a few weeks, but I needed to have the kind of raised energy that made me study and exercise intensively at the time. It soon calmed down and evened out.

I didn't have any physical issues such as those described by you, but I would have stopped the med immediately if I'd had any of them after taking it, as I am also someone who never gets ill (let's forget the mental stuff). I have to say that anti-convulsants have always made my vision blur on and off until i get used to it. No fever, though.

Can you get a second opinion? Not just for the urgent issue of her Lamictal intake and fever, but also for her diagnoses, if you both feel you don't have confidence in the doctor.

I really hope she gets better soon and that you can get this sorted out.

Take care.

[tryp]

It sounds like you're pretty concerned, which is totally valid. I'd be really concerned if a child of mine suddenly came home with some hardcore psych dx' like that and then got really sick from the meds.

I have to say, though, she IS 21, and since this tends to be a first person site, it might be more beneficial to have her come and talk to us directly.

[crazynotstupid]

I once went to see a therapist cuz I had some issues. Dx? Bipolar I. Now, OK, I cheated--told him I thought I was bp, explained why, we went over things in detail. Still. If you go over things in detail you CAN arrive at a "quick" dx. Don't go thinking the pdoc pulled it out of their ass just cuz, their most likely was a good reason.

Second. The symptoms. Could well be the lamictal, I suppose. Some are more well known lamictal side effects. UTIs, I hadn't heard of--could be that that, the sore throat, the cough and the fever are related.

And also yes, this being a first person site, best that she comes here directly--it's always easier to talk to the actual person (I find this to be so very true at work as well...)

[NYCMomOf3]

Firstly, I want to thank all of you that have replied. I really appreciate it.

Both my husband and I are pretty concerned about the speediness of the diagnosis. Both of us as teens saw either psycologists and/or psychiatrists so we are not completely clueless as to what it is like.

My daughter is still running a pretty decent fever. Last night when I got home she still had a 102 temp. She does not appear at this time to be getting better, which is still a concern. She has not taken anymore of the Lamictal. I think she is going to try to look for another doctor to get a second opinion as well.

For crazynotstupid, here is the link to which it states that UTIs can also be a side effect.

http://www.pdrhealth.com/drugs/rx/rx-mono....l&contentId=

Some others....

http://health.healthcare.com/DrugFactsheet...id=559&pg=2

Again, thanks for all the input. I am definately going to tell my daughter about this site. I think it will be beneficial for her. You all seem to have a good deal of knowledge on these issues and these drugs. She may be 21 but, if any of you are parents as well, she still lives at home with me and will always be my "baby".

Just want her to be well.

Thanks again and any other advice would be helpful.

[Amy10]

Firstly, I want to thank all of you that have replied. I really appreciate it.

Both my husband and I are pretty concerned about the speediness of the diagnosis. Both of us as teens saw either psycologists and/or psychiatrists so we are not completely clueless as to what it is like.

My daughter is still running a pretty decent fever. Last night when I got home she still had a 102 temp. She does not appear at this time to be getting better, which is still a concern. She has not taken anymore of the Lamictal. I think she is going to try to look for another doctor to get a second opinion as well.

For crazynotstupid, here is the link to which it states that UTIs can also be a side effect.

[link=http://www.pdrhealth.com/drugs/rx/rx-mono.aspx?contentFileName=Lam1217.html&contentName=Lamictal&contentId" target="_blank]http://www.pdrhealth.com/drugs/rx/rx-mono....l&contentId[/link]=

Some others....

[link=http://health.healthcare.com/DrugFactsheet.aspx?id=559&pg=2" target="_blank]http://health.healthcare.com/DrugFactsheet...id=559&pg=2[/link]

Again, thanks for all the input. I am definately going to tell my daughter about this site. I think it will be beneficial for her. You all seem to have a good deal of knowledge on these issues and these drugs. She may be 21 but, if any of you are parents as well, she still lives at home with me and will always be my "baby".

Just want her to be well.

Thanks again and any other advice would be helpful.

I can understand your concern and it's great that you're being so proactive. If only all parents were!

I think she's right to get a second opinion. I have noticed that some people do exhibit symptoms of intolerance to certain psychiatric drugs, symptoms that I have not seen noted in any official literature on the drugs.

One friend came out in slightly raised welts on her chest after trying an old anti-psychotic that I was fine on for many years. In all my research on the drug, I never came across that as a side effect in any literature.

Also, when I first started Lamictal, for the first year or so, I would get twitching, rolling eyes at times. I complained to my psych that it seemed directly correlated and he seemed sceptical. A few years later , it popped up as a side effect on the PIL. The second link you put in to your email is immensely comprehensive in a way the PIL wasn't to start with.

Point being that I am now much more open to undocumented and 'interesting' ways that drugs can adversely affect us.

Anyway, I hope her fever is abating somewhat and that she finds a doc she is happier with.

[Littlewing]

Just wanted to say that I take Lamictal but haven't had many of the issues that your daughter has.

Like many others, I think you should get a second opinion on the health concerns, if only to put your mind at rest. A temperature of 102 is pretty high, I'd be worried too, but of course a UTI can cause a raised temperature, so it may just be that. When I started Lamitcal, I did have the slightly blurred vision, definite muscle aches, pretty persistent headaches for a couple of weeks, a little nausea, trouble sleeping etc. It could be possible that all these symptoms were simply waiting there and have nothing to do with the introduction of Lamictal, but it is certainly worth investigating further.

I would be a little concerned at such a quick diagnosis of psychiatric conditions too, and would also probably get a second opinion. I'm sure that diagnoses CAN be made quickly in obvious cases of psychiatric disorders, but as you say that your daugher has only exhibited symptoms of depression, then I would definitely be wary of jumping the gun on this one.

Hope you get some answers soon

LW

[crazynotstupid]

I still want to hear from the daughter. Until then I have to have no doubts as to the dx of BP II. After all NONE of us know the symptoms or history that led to this "quick" dx.

[NYCMomOf3]

Thanks again everyone.

Her fever has now abated and she is feeling a bit better. She has not taken any doses for almost 3 days now.

I am going to get her to come on here. Again, I think that it would be helpful for her since she is just beginning the process of seeing someone about what is troubling her and should she be prescribed another drug, I think that there is much guidance for her here.

All comments are greatly appreciated. Thank you again.

[AnneMarie]

FWIW, I think she is right to get a second opinion. I believe it very possible to accurately diagnose bipolar w/in an hour depending on symptoms and history. The same might hold for borderline. I'm very reluctant to think it reasonable to diagnose both in a single initial session. Untreated bipolar can look like borderline and borderline can look like untreated bipolar. IMO (again fwiw since I'm definitely not a professional) the person has to either have the bipolar stabilized for a while or fail to stabilize on meds before a borderline personality disorder diagnosis can seriously be considered. For many reasons, I'd walk away from that dual diagnosis, and start over with a different pdoc and not mention the prior assessment so as to not unduly sway the evaluation.

As to Lamictal and becoming sick, I'd stay off the Lamictal but would later be willing to trial it again. Lamictal is a very good stabilizer for many and the one with the most antidepressant properties. The sickness could have been coincidental. People do get the flu, bugs, etc, so I wouldn't write it off as a permanent no go unless a similar response occurs on the second trial. I would, however, tell the prescribing pdoc about the first experience so that s/he was aware of it.

And, yes, it's best if your daughter posts herself even though I think it cool that you care enough to seek out info for her.

[Nicole87]

Hello all. I'm the daughter in question. Everything that my mother listed were side effects of taking the Lamictal Starter Kit for the first 3 days. It started with headaches that were bad but were able to get over. Next came the fever along with twitching eyes, poor coordination, vomiting, insomnia, loss of appetite and hives.

I did take this medication because it was prescribed to me. I did look into the information I found on the internet and read up on both sides of drug. It was a hit and miss thing when people reacted bad to the medication and since I have no prior allergies to anything I believed I should be okay. I was wrong.

My mother wrote on here to let you know about one case that happened and to warn you that not everyone has the same effect. This medication is prescribed for two totally opposite disorders so you have to keep that in mind. Two days after the hospital and being off of this medication, everything went away. No more fever, no vomiting, no problems. And if you do actually take the time to look it up you'll find everything along with UTI was listed as a side effect.

Research before taking something you don't know 100% about and research before debating as well. Just because you didn't have these symptoms doesn't mean you can't or won't. Thanks.

[AnneMarie]

Hi Nicole,

I'm glad you are feeling better.

There are many other meds that have a risk of allergic reaction, some more than Lamictal. It might be in your interest to mention this reaction to any doctor prescribing you medication in the future (or at least ask your GP if you should do so).

Many other stabilizers do not carry the same allergy risk. Don't let this experience stop you from seeking help.

I am not a professional, only a person with bipolar. With that qualifier, I'd seek a second opinion. I'd be concerned about the dual diagnosis as well as your pdoc's response to your Lamictal reaction.

Many psychiatrists are very good at what they do. If you do in fact have bipolar, you will need medication and life time treatment to manage the illness, stop it's progression, and lead a normal life in general.

I wish you luck and health, and again, am happy to hear you are okay.

[SashaSue]

I just wanted to mention, since it seems no one else has, that often enough, start up of these meds sucks. I don't remember what Lamictal was like, but others have been quite wretched. But, after a little while, as I adjusted to the med, the initial side effects wore off, and it was fine. So, your pdoc may have been thinking along those lines in suggesting you stop taking it.

[kei13]

Glad to hear you feel better... do look for a second opinion and if such is same as previous go ahead and try lamictal if admonished to do so. I've taken quite an array of meds and I've read such's info each month, everytime I refill my prescriptions... my point is that I've noted that many of these possible side efects are ubiquitous in meds when compared.

Your body does need some time to get adjusted to medication. So even if your dx is other than BD and / or your rx is other than Lamictal, keep in mind that the side effects will be there at first untill your body gets used to it....

Good luck!!!

[crazynotstupid]

Research before taking something you don't know 100% about and research before debating as well. Just because you didn't have these symptoms doesn't mean you can't or won't. Thanks.

I am glad you came to post. But, please, realize that we ALL (for the most part) do the research before talking about these meds. I don't tend to talk out my ass and it pisses me off when someone assumes that I do.

ASsUME=makes an ASS out of U and ME.

Like many, maybe most, of us, I ended up here cuz I was scared of that fist med I was scripted. I have since learned a lot. Never doubted any of your symptoms--btw, you were likely only scripted lamictal for the BP II; the borderline generally requires talk therapy.

Glad you're feeling better. Always good to seek a second opinion if you feel the first is wrong. Never be afriad to try another med just cuz the first went bad. It's what we here call the "med-go-round". Been on, dunno, 12-13 myself.

[Silver]

Just passing through between jobs.

Nicole, glad you're feeling better. Many of us here are in fact aware that not all medications have the same effects for all humans. Stick around a bit. Read. That should come through loud and clear. We're on an acronym basis with that particular concept.

Nicole's mom and Nicole: a urinary tract infection isn't really a "side effect" of a drug. It's a result of colonization with bacteria. If you read the link you'll posted, you'll observe that it mentions UTI in the "additional side effects in children" section. That's some sloppy writing on their part; they mean "propensity to UTI," and, because Nicole is clearly an adult, and, I am going to assume, one who is sexually mature and estrogenized... that's not an issue for her. I can explain this in boring detail, if you really want me to. ?

One take-home out of this: Always note when they break out the "for children" (or elders) side effects. There's a reason for it. As Nicole has suggested, actually take the time to read the whole thing. Carefully.

I'll add that I've had what seemed like ghastly med reactions - and were, in fact, viral infections, seasonal allergies, or other things. Correlation doesn't equal causation. We're often diagnosed at times of significant mental and physical stress, and we're perhaps prone to react oddly, or we're already susceptible to infection, dermatologic reaction, etc. I've retried drugs to tremendous benefit, and I've gone on to other meds to great benefit, and I've scrapped a lot of meds. I have a rather severe immune reaction to Lamictal that shows up after a few months. The psychiatric benefit has been so significant that I've retried it twice, but it's not to be. (The really evil immune reactions, by the way, don't tend to occur in the first week, unless you're cross-sensitized from other anti-epileptic drugs for some reason... and usually not even then. Go through the literature on it. Phelps has a good writeup at psycheducation.org that is a good starting place.)

It's frustrating.

Hang in there, because you sound like you want to be well and make some changes, and it sounds like your family is supporting you in that.

[N&P]

Dunno if this was said...it's normal to run a fever with a UTI...it is an infection. Fever causes headaches, body aches. Infection can cause them too, along with sensory distortion (loss of coordination).

Hives, nausea...was this after you started the antibiotics? If so, consider an abx reaction...

Two days after being out of the hospital and off of Lamictal, you felt better...Was this also after 2 days on antibiotics?

Just a thought...

EDIT: Oops forgot a part...UTIs can also cause nausea and vomiting if the infection is advanced enough.

[Karin]

Hi, Nicole,

Glad you are feeling better - I hope you are still reading the board? I am also not a professional, but I am still just very concerned about the speed with which you were diagnosed. I agree that a second opinion, without mentioning the first opinion and episode, is a very good idea. Being wrongly diagnosed with Bipolar is not what one would want.

Though I was able to present my p-doc with my GP's recommendation, my own long history, two suicide attempts, a history of numerous manic episodes, he was STILL hesitant to confirm a BPII diagnosis during a first 1-hour appointment. It was only with subsequent telephone discussions on some other issues that he confirmed - "My word, there is NO doubt!".

My understanding is that a sound p-doc would first exclude all other possibilities before getting to Bipolar, as it is a very difficult diagnosis to reach accurately?

Also - the Bipolar medications are pretty severe - I would definitely not want to have to take them if I don't have to.