How can you tell you are on too much Lamictal?

[Lady Krazy Kat]

Note: I just noticed that this was VERY long. If you don't want to read the whole thing, you can just look at the questions

Just a little background on my treatment before my question. I am currently in a women's trauma IOP (intensive outpatient, which is 3 hours a day, 3 times a week), which is DBT based. I am on a slew of medications, Lamictal included, which take the edge off of symptoms but don't fully treat it, but there IS no perfect med combination for C-PTSD-- it's all about therapy therapy therapy. The Lamictal was added by my regular OP pdoc as creative attempt to treat my PMDD since the "standard" treatments have not helped; we thought it could help certain PTSD symptoms as a side benefit.

So, I have a pdoc through the IOP, and I have an OP psychiatrist that I'm not allowed (insurance-wise) to see while I'm in the other treatment. I was crying in the new/temp pdoc's office last Friday (and NO ONE in IOP had ever seen me cry...emotional numbness is one of my primary, and most troubling, symptoms.) I wasn't feeling depressed; I was feeling anxious about finances, the fact that I can't work at present, but have no income. I felt the crying was a GOOD thing, because I was actually connecting to some feelings of grief/sadness about work and having limited social support, which is nearly impossible for me.

The pdoc immediately brought up the topic of increasing my meds. He first wanted to raise zoloft, but I said I'd prefer not to. I know for a fact from past experience (actually a couple past rounds on zoloft) that doses higher than 100mg have made me feel even more like an emotionless zombie. Feeling like a zombie makes me feel dissociative. When I said no, I felt like he was mad at me (probably not true), which is a trigger for me. I shut down, became passive, and a little anxious. I usually have no problems advocating for myself with a female doctor or therapist, but I often "lose my voice" when it comes to male practitioners. I also cry easily around men but not around women. I can count on one hand the number of times I have ever cried in front of a female therapist, in all my years of therapy. But anyhoo. He then wanted to increase the Lamictal instead. (I dunno, it almost seemed like he was looking for something, anything to increase, though there wasn't a reason to.) Because I was feeling vulnerable and childlike, I agreed, in spite of my prior attempt with Lamictal really screwing up my cycle when I was at 150mg, thus causing me to have 2 PMDD episodes each month. (I was also on BC pills back then, so that could have also played a role.) But I just found myself opening my mouth and saying "okay." I regretted it immediatley after leaving but decided to go ahead with it anyway, b/c he only wanted me at 125mg for the moment.

I took my first additional 25mg that same day when I got home. The rest of the day I felt okay, and my sleep was sufficient but restless. Saturday, I had tremendous difficulty sleeping and a severe nightmare. Sunday, I was very anxious and kinda spacey and slept only 4 hours that night, despite exhaustion. Starting Monday, I was experiencing something between extremely poor concentration and dissociation. I missed my exits several times. I had to do some walking for an errand, and I would suddenly become really confused and disoriented and forget where I was and had no recollection of having walked a couple blocks. Things looked unfamiliar to me. I also couldn't focus on any task whatsoever-- cleaning, cooking (destroyed my dinner and made a huge mess), talking on the phone, taking out the garbage, etc. My brain kind of felt like it would short circuit and then suddenly I'd remember something to do, totally forgetting what I was doing, and then when I went to do the thing I "remembered," I forgot it by the time I tried to do it. I could not keep a thought in my head, and sometimes I'd just be staring at an object but blankly, without any thought or awareness whatsoever. This has happened daily since Monday (Monday was the worst day because I had a lot to do, so these issues impacted me more). I also have had an intense headache and a lot of restlessness and agitation (mostly physiological rather than emotion-- like I have restless leg syndrome and need to keep moving-- but after enduing this for several hours my anxious increases and increases, so it becomes emotional too). I am back in program tomorrow, and I will definitely ask to see him. My therapist wanted me to give it until next Monday, which I agreed to, but I cannot tolerate it anymore. I am missing out on stuff in treatment, it's taking me hours to complete what I normally could in about an hour (b/c of the concentration and/or dissociation), I see no logical purpose in me taking a larger dose, and it wasn't "broke" so there's no need to fix it IMO.

So, the questions:

1.) How can you tell if your dose of a med is too high? What does that mean? I ask because in my experience pdocs tend toward wanting to increase meds. Barring medical emergies, do they ever suggest or think that a lower dose is better?

2.) Why would I suddenly start getting symptoms now? I had no side effects, other than a headache for the first few days, with each dose increase. I thought the side effects happen in the beginning. It just seems really odd because this is the smallest "percentage" increase---25%-- as opposed to a 25 to 50 jDoes ump, which is a 200% increase.

3.) If you've had a dose increase, then go back to a lower dose (which was adequate), does the lower dose tend to work again. Also, once these symptoms/side effects have been activated, do they continue when you are at a lower dose?

4.) I jumped from 100 to 150 in the past and had no side effects like these. Is it possible to have a no side effects on a med once time, and then during a different course of treatment, to suddenly start having side effects?

5.) Does this make sense as a side effect of Lamictal? I know the headaches definitely are a common side affects, as well as cognitive dulling. While there obviously is some kind of cognitive dulling, this seems a little beyond that, with the "not knowing where you are, when you are, what are you doing" thing.

Sorry for the novel and for this possibly not making full sense. Hopefully if you wanted to just skip to the questions, you did. Thanks in advace for any feedback or advice.

Edited for: missing words and weird grammar stuff that happened due to the "Lamictal stupids"

[tryp]

I've had that kind of thing on Lamictal - especially going to do something and forgetting what I was doing by the time I get there, but yesterday I got lost in the building where my DBT group is (been going there since January) - I had to ride the elevator up and down three times because I didn't recognize any of the floors. Scary as hell.

Medications can behave different ways at different times, I think. Sometimes it interacts with stress you are already under, or what the general state of your condition is. Even small increases of Lamictal have been known to cause me brain problems.

My pdoc is generally pretty conservative with meds - but then, I am quite happy to have mine raised if I am having symptoms. There is no real absolute guidance on when to raise and when to hold IMO. In the end it's your body and if you want to hold out, that should be your choice unless it's to the point where you are completely out of your mind.

I would try talking to the doctor again. Could you write down what you want to say or something so that you can't get intimidated into silence so easily.

[Lady Krazy Kat]

Hi Tryp. Thanks for the response. I did a pros/cons list before I met with pdoc (I'm in DBT too, I forgot if I mentioned it in my last). The only "pro" I actually came up with was that "the doctor might think I'm not compliant" and "I don't want to disappoint my therapist who told me to give it a week," which are "emotion mind" reasons (i.e. fear of authority figures being "mad" at me). The cons were numerous and based mainly in my knowledge of my own body and prior responses to medication. The decision to stop the higher dose was based in "wise mind." I presented it to pdoc (did a little DEARMAN), and he agreed that I should go down to the original dose. (Sorry I keep referencing DBT skills. It's just cool to know there's someone else that is going through it too.) Its been a couple days on the lower dose, and my "brain malfunction" has improved but is still a little challenging (i.e. staring blankly into my underwear drawer when I went to take my meds, which are NOT kept in the underwear drawer). However, the best thing is that my sleep is better...but that could be that he put me up on my trazodone. But the increased Lamictal was also making me worse.

Thanks again!

[melissaw72]

I am on 600 mg lamictal and blood levels remain low of it. I've been on it so long I can remember initial side effects. Now I feel like a dope and seem so stupid now though -- with memory loss, stuttering/stammering words, handwriting bad, etc. These things could also be from the general cocktail of meds that I am on too, but Lamictal does contribute in some way. I havent had a dose change in a long time, but after reading some things on this site I refuse to take more unless something is life-threatening to me that I have to take more. Thanks for bringing these questions up.

What does your pdoc say about these questions? Does s/he have answers?

[phatemu]

I chase my tail on lithium + lamotrigine.