Lamotrigine or lamictal for Bipolar

[hopelessoptimist]

Hello everyone,

I was diagnosed as bipolar 4 years ago, but it was not until this year that I sought out help. I'm now seeing a psychiatrist and psychologist. I was dx bipolar and started lamotrigine in February, starting with 25 mg a day. At about 50 mg a day I was an emotional wreck. About a month ago I had gotten up to 100 mg a day. That's when I started to feel really good... no, amazing. I had a better, more positive outlook on life, confidence, assertiveness, motivation, healthier and wiser life choices, CALM, etc. However, after 3 or 4 days it wasn't working anymore; I was extremely emotional. My doctor took it up to 150 mg, which helped, but again I bottomed out after a few days. She then upped the dose from 150 to 300 mg a day!! I wasn't depressed, but my thoughts were very cloudy. I was unable to put my thoughts into words to hold conversations, I couldn't remember something someone said 15 seconds later. I saw my doc again last week and she changed it from 300 back down, to 225 a day. Two days on that dose, I woke up Saturday morning VERY irritated. When I got out of bed I went to the mirror to brush my hair and for some reason just started sobbing or absolutely no reason, for an hour. My doctor can't see me for 3 days, so I took 250mg last night instead of 225. I still don't feel right. I go from calm to irritated to very tense to crying. I don't know what to do. I don't like what my doctor is doing, and feel as if she doesn't really listen to me when I do go there. The best I've felt on this medicine was at 100mg, but that only lasted a few days. Help!! Has anyone had similar problems with lamictal / lamotrogine? I would love to know I'm not the only one struggling to become mentally stable. I don't know what I did before the medicine, I just want it to stay stable.

[shesellsseashells]

You are not the only one struggling: I can relate and I am sorry you're dealing with this.  I've been on Lamictal/Lamotrigine for a few years now.  I was on 200 mg for a couple of years and had some cognitive trouble, finding words and so forth, but I've found it has gotten a bit better with time.  I found the med to be more beneficial after my pdoc upped my dose to 400 mg a few months ago.  It really helped to stabilize my mood and I found that my other medications worked better.  Perhaps you're not at the right dose for you yet?  I hope you stabilize and get some relief from your symptoms soon.

[Chimako]

When I first started lamotrigine, it was very very activating.  My mood was so euphoric I couldn't even be bothered to go to work.  I eventually started lithium, got rid of the hypomania and the euphoria caused by the lamotrigine.  Lamotrigine was reduced since it was obviously not controlling my moods but I still take 200mg in case of depressive episodes.  It took at least 6 weeks to adjust when I initially started taking it, then every titration down from 300mg caused a couple weeks of misery of various kinds.  Once a stopping point was reached, after a month or so, the side effects lessened and it was livable.  I still lose my words, but hell, that was happening much much worse when I was hypomanic or mixed episode.  Before meds, I even asked my gdoc several times if he thought I had alzheimers because I kept losing words and pacing the floor.  

[tryp]

Lamictal is one of those medications that can be really rocky to get started with. Ideally it helps to stay at a stable dose for at least a month to wait for things to settle.

I also had a lot of trouble with lamictal when i took it all in one dose. Taking it twice a day has made things way better.

When I first started it there were a lot of ups and downs but after I had been on it for a couple months I noticed a big difference and now I don't have many side effects at all.

[tamagotchi]

How long were you on the 300mg?

 

The increase from 150 to 300 is a really big jump and it's not surprising that you might have problems initially.  My experience is that a big increase in Lamictal (or really any increase) can result in significant cognitive problems as you describe, mental slowness, difficulty putting together sentences, memory problems etc.   These cognitive problems usually go away as you adjust to the dose.  Or 300 mg may be too much for you, but you wouldn't know for sure until you had more experience with the dose.

 

And, a big decrease (300 to 225) can definitely be destabilizing (as you describe).  This might be a short term problem and then you would adjust.  Or, 225 may be too low for you.

 

I am not sure why your pdoc would increase from 150 all the way to 300, generally on Lamictal you would increase more slowly, for example 150 to 200 to 250 to 300.  A slower increase is better for various reasons, (1) easier to adjust, (2) your ideal dose may be 200 or 250 instead of 300, (3) rapid increases in Lamictal have an increased risk of dangerous rash.

 

As for the instability you've had on the way up to 150, that's normal, a lot of people have problems during the initial titration going up to a therapeutic dose.  I had terrible problems around 75-150 with very rapid mood swings that were worse than usual.  It smoothed out around 200.

 

I think it's encouraging that you had a good response at 100 and 150 (even if short lived).  But it might take time to find the right dose.  Hang in there, and keep talking to your pdoc.

Edited April 29, 2014 by tamagotchi

[saranodamnedh]

I take both. 200mg Lamictal and 1800mg Trileptal (which is high, so it seems). Trileptal wiped out the highs and anxiety, and Lamictal knocked out the weepiness and suicidal thoughts. Of course, ymmv, and it seems as if Trileptal doesn't work for everyone, but I love it and preach about it all over these boards.

[hopelessoptimist]

Hello everyone and thank you for your thoughts and support!! Just a few weeks later I feel great again! Turns out, to my relief, the medicine wasn't working because of another medicine, not me. I had been taking phetermine prescribed by my pcp and my psych didn't know about it. Almost 2 weeks off the diet pill and I have not had one episode. Losing more weight just isn't as appealing to me anymore as mental stability is. Now I'm not saying I feel perfect ; I still have a bit of irritability here and there, but I think that's normal. Oh!! I forgot to mention...I'm back down to only 100mg and my memory/cognitive problems have subsided:D I am so happy. Thanks everyone!!! One more thing, how do I receive notifications for when someone replies to my post other than bookmarking and revisiting the page?

Thanks!!!

OptimisticallyHopeful

[Bubble]

Glad you're feeling better! If you think about it, I'd say mental stability would do more for weight loss than diet pills, in the long run. It's harder to manage your diet and exercise when you feel terrible.

 

To change your notification settings, click your username in the top right corner of the webpage. Then, click "Settings". In the list on your Settings page, click "Notification Options". It will take you to a page where you can change your notification options, which includes turning notifications via email on/off.

[hopelessoptimist]

Does anyone else think it's weird I was not diagnosed with a specific type of bipolar disorder? I've been on 100 mg and no depression for 2 weeks! However, I feel like I'm in a rut again. Wondering if maybe I have another condition and/or need more meds. Is it possible my medicine helps for depression but not the thought process/emotion control/irritability/inconsistent wants and needs...? :/

[Bubble]

I was diagnosed Bipolar NOS until my psychiatrist had more information to go on. Basically, until she got to know me and my behavior patterns better. Later, that diagnosis was changed to Bipolar I.

 

Maybe you're not on the "right" medication for you. Also, I have to take Quietapine in addition to the Lamotrigine. The Lamotrigine helps with the depression, but I need the Quietapine to deal with mania, irritability, racing thoughts, impulsivity, etc. If you're still having these problems, tell your pdoc. You said in your original post that you feel like they don't listen to you, and if that continues, maybe you should find another pdoc. Psychiatrists are not infallible, and some are definitely better at treating Bipolar Disorder than others.

 

Also, are you seeing a therapist? My medication helped my symptoms to the point that they were manageable, but having untreated Bipolar Disorder for so long led to a lot of destructive thought patterns and behavior that I needed to work on through therapy. My therapist also has pretty good judgment when it comes to which symptoms are brain chemicals and which are thought patterns.