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19 hours ago, lisa2712 said:

Yea, I was just switched to an HMO insurance. 

Ugh, I'm so sorry to hear that. HMOs are the worst. An HSA can be terrible too but at least it's a PPO network. If I went on an HMO, I'm not sure how I would function. It's a total change to how you actually have to do healthcare.

19 hours ago, lisa2712 said:

LTG 150 mg has made a positive difference, even though it's a low therapeutic dose. My only problem is one side effect, which I can't deal with. :( 

I take it that's the neck pain?

19 hours ago, lisa2712 said:

Yea, I'm not really sure why my psychiatric PA tells me I need a mood stabilizer, but I have felt less anxious and better mentally on LTG 150 mg, more pulled together rather than being all over the place. I had a previous (over 10 years ago) psychiatric nurse practitioner tell me that I need to be on an Antipsychotic, and at the time it puzzled me, because I was going to her for social anxiety. 

Well in some cases anxiety is due to a glutamate problem. You can suppress glutamate with the help of benzos, which increase GABA activity (GABA being the OPPOSITE of glutamate). Lamotrigine calms and modulates glutamate activity. For many, this can have a profound effect on anxiety. My mother-in-law takes LTG at 125mg I believe and it calms down her anxiety and neurotic behaviors quite a bit.

19 hours ago, lisa2712 said:

Yes, I think my last option is Abilify. If Abilify doesn't work out, I'm probably changing psychiatrists. I took it for 2 weeks and did feel more anxiety, but others here have told me it can be more calming at higher doses. I want to continue with my weight loss and caring about my diet. Seroquel made me not care about my diet or losing weight, which is why I went off it. The same thing happened when I was on a higher dose of clonazepam. I have 100 lbs to lose before I'm at a healthy weight and BMI. 

Abilify is supposedly more weight neutral than most. Although in the presence of an antidepressant, this can kind of be invalidated. For example, patients in the schizophrenia and bipolar disorder clinical trials that were taking Abilify as monotherapy (no other medications) didn't have much weight gain, but the patients in the MDD adjunct trial (taking Abilify with an antidepressant) had weight gain. This is probable due to 5HT2C partial agonism on Abilify's part. In the absence of an antidepressant, serotonin levels would be lower, and thus Abilify would act as more of an agonist at 5HT2C. This activity is what makes you feel full (i.e. satiety). However, when one is taking a serotonergic antidepressant, Abilify acts as more of an antagonist. This can make you feel more hungry, but it has the added positive effect of increasing norepinephrine and dopamine release in the PFC among other brain regions which can have positive antidepressant effect.

18 hours ago, lisa2712 said:

Yea, that's one of my worst faults, always being on-edge and anxious in social situations, and not being able to relax like a "normal" person. It was nice to be able to relax a little bit while I was on LTG 150 mg. I was able to sit down at the mall and relax, although my anxiety was still there and increasing the longer I stayed in the mall. 

If you found Abilify stimulating at the lower doses, I would recommend Rexulti. It's very chemically similar to Abilify but it's calming in lower doses and gets stimulating as you increase (kind of Abilify's opposite). Less of a chance of akathisia or agitation with Rexulti as well. They found that those who couldn't tolerate Abilify often tolerated Rexulti without issue. Rexulti can potentially cause more weight gain than Abilify, but if you keep to lower doses like 1mg and below, I've found the weight gain to be there but it's minimal. I'm taking Rexulti with Depakote which are both KNOWN weight gainers, but Trintellix is now being shown to increase weight for some as well. So I should be gaining weight like crazy but I've only gained maybe 10-20 pounds. Additionally, in long-term trials, the weight gain from Rexulti plateaued after ~6 months.

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2 hours ago, browri said:

Ugh, I'm so sorry to hear that. HMOs are the worst. An HSA can be terrible too but at least it's a PPO network. If I went on an HMO, I'm not sure how I would function. It's a total change to how you actually have to do healthcare.

I take it that's the neck pain?

Well in some cases anxiety is due to a glutamate problem. You can suppress glutamate with the help of benzos, which increase GABA activity (GABA being the OPPOSITE of glutamate). Lamotrigine calms and modulates glutamate activity. For many, this can have a profound effect on anxiety. My mother-in-law takes LTG at 125mg I believe and it calms down her anxiety and neurotic behaviors quite a bit.

Abilify is supposedly more weight neutral than most. Although in the presence of an antidepressant, this can kind of be invalidated. For example, patients in the schizophrenia and bipolar disorder clinical trials that were taking Abilify as monotherapy (no other medications) didn't have much weight gain, but the patients in the MDD adjunct trial (taking Abilify with an antidepressant) had weight gain. This is probable due to 5HT2C partial agonism on Abilify's part. In the absence of an antidepressant, serotonin levels would be lower, and thus Abilify would act as more of an agonist at 5HT2C. This activity is what makes you feel full (i.e. satiety). However, when one is taking a serotonergic antidepressant, Abilify acts as more of an antagonist. This can make you feel more hungry, but it has the added positive effect of increasing norepinephrine and dopamine release in the PFC among other brain regions which can have positive antidepressant effect.

If you found Abilify stimulating at the lower doses, I would recommend Rexulti. It's very chemically similar to Abilify but it's calming in lower doses and gets stimulating as you increase (kind of Abilify's opposite). Less of a chance of akathisia or agitation with Rexulti as well. They found that those who couldn't tolerate Abilify often tolerated Rexulti without issue. Rexulti can potentially cause more weight gain than Abilify, but if you keep to lower doses like 1mg and below, I've found the weight gain to be there but it's minimal. I'm taking Rexulti with Depakote which are both KNOWN weight gainers, but Trintellix is now being shown to increase weight for some as well. So I should be gaining weight like crazy but I've only gained maybe 10-20 pounds. Additionally, in long-term trials, the weight gain from Rexulti plateaued after ~6 months.

Yes, the neck tightness and pain was the reason I decided to go lower to 125 mg. 

I take klonopin, 2 mg a day total. Yes, I did notice a decrease in social anxiety at 150 mg. 

I need to be able to lose weight and care about losing weight. You say Abilify tends to be weight neutral, but does it mean I will still care about my diet and weight loss? 

Also, I feel LTG acts different on me at different doses. For example, when I was titrations up from low doses (25 mg, 50 mg) I had episodes where I felt like I couldn’t breathe. I’d wake up in the middle of the night almost crying because I felt like I couldn’t breathe. As I got to 100 mg, my body adjusted and I stopped having that side effect. So, I wonder if I went to a higher dose, 175 mg or 200 mg, if my neck tightness and pain would subside, or if my body would get used to it. 

I think I can handle the cravings for junk foods , but I need to care about my diet and weight loss. It takes work for me to lose weight, and I have to care about losing weight and counting calories. 

Is Rexulti a mood stabilizer? Or an add-on for depression (which I no longer have.) 

I can’t gain any weight now or even stay at my current weight. I need to lose weight. Maybe this means I can’t go on a mood stabilizer now. My mom and I were talking about it, and my physical health has to come before my mental health. I snore so loud my parents tell me they can hear me snoring from the other side of the house. 

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1 hour ago, lisa2712 said:

I need to be able to lose weight and care about losing weight. You say Abilify tends to be weight neutral, but does it mean I will still care about my diet and weight loss?

Hard to say. You're taking Cymbalta which is why I asked earlier if your signature is correct. Theoretically taking Cymbalta Will make Abilify more weight positive than weight neutral but it varies so much from person to person. And they SAY an AAP is less likely to cause weight gain but there's usually not enough evidence to back that up. For some there is evidence but there will always be a fringe group of people who still gain weight no matter what. I resisted weight gaining medications for so long because I was afraid of it and then I basically ended up moving to mostly gainers and I haven't gained THAT much AND I feel a lot better. So your mileage will definitely vary.

1 hour ago, lisa2712 said:

Also I feel LTG acts different on me at different doses. For example, when I was titrations up from low doses (25 mg, 50 mg) I had episodes where I felt like I couldn’t breathe. I’d wake up in the middle of the night almost crying because I felt like I couldn’t breathe. As I got to 100 mg, my body adjusted and I stopped having that side effect. So, I wonder if I went to a higher dose, 175 mg or 200 mg, if my neck tightness and pain would subside, or if my body would get used to it. 

Not surprising. LTG always makes things worse before it makes them better. But if you can get through the titration to 200mg, most end up feeling a lot better about it.

1 hour ago, lisa2712 said:

I think I can handle the cravings for junk foods , but I need to care about my diet and weight loss. It takes work for me to lose weight, and I have to care about losing weight and counting calories. 

Well any weight gain through 5HT2C is based almost entirely on appetite. It controls whether you feel full or not. Not necessarily whether you gain or lose weight. Histamine antagonism on the other hand can definitely cause weight gain.

1 hour ago, lisa2712 said:

Is Rexulti a mood stabilizer? Or an add-on for depression (which I no longer have.) 

The only TRUE mood stabilizer is lithium technically. Depakote, Lamictal, Tegretol, and Trileptal we're all anticonvulsants before they were used for mania. And even the typical antipsychotics were supposed to just be anti-histamines before they realized what they ACTUALLY did. So really, Rexulti is an atypical antipsychotic. It doesn't have an indication to treat mania in bipolar disorder but it is approved for schizophrenia and as an add-on for MDD much like Abilify. But it's very different from Abilify in many ways.

1 hour ago, lisa2712 said:

I can’t gain any weight now or even stay at my current weight. I need to lose weight. Maybe this means I can’t go on a mood stabilizer now. My mom and I were talking about it, and my physical health has to come before my mental health. I snore so loud my parents tell me they can hear me snoring from the other side of the house. 

But if you look at it another way, it's really hard if not near impossible to maintain good physical health if you don't maintain your mental health. So it might be good to look at generally weight neutral options. I'm thinking specifically of ziprasidone (Geodon) and lurasidone (Latuda). The former is already generic, and the latter will have generics out shortly from what I've been reading. Both have been shown to have minimal impact on weight (meaning you MIGHT gain a few pounds in the beginning but you wouldn't notice if you weren't weighing yourself) and a good appetite and physical exercise will help ensure you're part of the positive end of that statistic regarding weight.

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5 hours ago, browri said:

Hard to say. You're taking Cymbalta which is why I asked earlier if your signature is correct. Theoretically taking Cymbalta Will make Abilify more weight positive than weight neutral but it varies so much from person to person. And they SAY an AAP is less likely to cause weight gain but there's usually not enough evidence to back that up. For some there is evidence but there will always be a fringe group of people who still gain weight no matter what. I resisted weight gaining medications for so long because I was afraid of it and then I basically ended up moving to mostly gainers and I haven't gained THAT much AND I feel a lot better. So your mileage will definitely vary.

Not surprising. LTG always makes things worse before it makes them better. But if you can get through the titration to 200mg, most end up feeling a lot better about it.

Well any weight gain through 5HT2C is based almost entirely on appetite. It controls whether you feel full or not. Not necessarily whether you gain or lose weight. Histamine antagonism on the other hand can definitely cause weight gain.

The only TRUE mood stabilizer is lithium technically. Depakote, Lamictal, Tegretol, and Trileptal we're all anticonvulsants before they were used for mania. And even the typical antipsychotics were supposed to just be anti-histamines before they realized what they ACTUALLY did. So really, Rexulti is an atypical antipsychotic. It doesn't have an indication to treat mania in bipolar disorder but it is approved for schizophrenia and as an add-on for MDD much like Abilify. But it's very different from Abilify in many ways.

But if you look at it another way, it's really hard if not near impossible to maintain good physical health if you don't maintain your mental health. So it might be good to look at generally weight neutral options. I'm thinking specifically of ziprasidone (Geodon) and lurasidone (Latuda). The former is already generic, and the latter will have generics out shortly from what I've been reading. Both have been shown to have minimal impact on weight (meaning you MIGHT gain a few pounds in the beginning but you wouldn't notice if you weren't weighing yourself) and a good appetite and physical exercise will help ensure you're part of the positive end of that statistic regarding weight.

I can ask my psychiatric PA about this (about trying 200 mg LTG, even though I have a bothersome side effect at 150 mg), but from what I’ve understood from her, she doesn’t increase med doses if the patient can’t tolerate a lower dose. 

I was on Latuda, but went off it because it made me very tired an hour after taking it. I had to take it with a late dinner at 7:30 pm, and by 8:30 pm I had to go to sleep. I was on it for over 1 month. 

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On 5/7/2019 at 4:22 PM, lisa2712 said:

As of today, I’m 3 weeks on the LTG 150 mg. A month is 3-4 weeks, so I don’t know if I should give it another week, but the side effects are starting to wear on me. I occasionally have slight headaches, but nothing serious. I am more tired, I want to sleep more, but I have things I have to do.

@lisa2712  Are you staying at 125mg? I've been titrated up to 150mg also (from 2 years on 100mg) I am getting tension headaches (pain behind eyes) everyday that do not respond to Ibuprofen, lower back pain, tightness in neck and tightness in chest. I feel like sh*t...and I have so much to work on.

Will I feel this way for weeks? I just can't deal. Everytime I change meds or add meds I feel either drugged or like I'm taking some sort of slow poison.

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Posted (edited)
5 hours ago, Blahblah said:

@lisa2712  Are you staying at 125mg? I've been titrated up to 150mg also (from 2 years on 100mg) I am getting tension headaches (pain behind eyes) everyday that do not respond to Ibuprofen, lower back pain, tightness in neck and tightness in chest. I feel like sh*t...and I have so much to work on.

Will I feel this way for weeks? I just can't deal. Everytime I change meds or add meds I feel either drugged or like I'm taking some sort of slow poison.

I was intending to stay at 125 mg LTG until I saw my psychiatric PA in 2 weeks, and I did for 3 days, but the rebound depression got bad. (So, I went up again, starting this morning, to 175 mg LTG. Maybe I’m being too hasty. My thinking was that the side effects from LTG 150 mg were just as painful as the depression I was experiencing when I went down from 150 to 125 mg. And as I had said, LTG’s side effects were different for me at different doses. At the lower doses (25, 50, 75 mg) I felt like I couldn’t breathe, and it would wake me up at night. That went away once I reached 100 mg. Using that logic, I’m trying a higher dose now (175 mg) , seeing if the neck pain and tightness will go away, or if my body will adapt to it, as it did with the breathing side effect. 

As for me, I was on LTG 150 mg for 3 weeks, and my uncomfortable neck side effect didn’t go away. And it may not make sense going up to 175 mg when I had side effects at 150 mg, but I’m going to try it anyways. 

Edited by lisa2712

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7 hours ago, lisa2712 said:

 And as I had said, LTG’s side effects were different for me at different doses. At the lower doses (25, 50, 75 mg) I felt like I couldn’t breathe, and it would wake me up at night. That went away once I reached 100 mg. Using that logic, I’m trying a higher dose now (175 mg) , seeing if the neck pain and tightness will go away, or if my body will adapt to it, as it did with the breathing side effect. 

As for me, I was on LTG 150 mg for 3 weeks, and my uncomfortable neck side effect didn’t go away. And it may not make sense going up to 175 mg when I had side effects at 150 mg, but I’m going to try it anyways. 

Yeah it's very weird. The chest pressure/breathing thing is scary. I've been on a higher dose in the past and didn't have that side effect. But then again,  when you have a break from a med and start up again, it can often affect you differently the 2nd time. Feeling a bit better, but maybe the med has worn off, I tend to feel worse right after I take it in the morning.

I also wonder why at lower Lamictal doses, titration is 25mg per week, whereas, my pdoc upped it immediately from 100mg to 150mg. Seems like maybe too big of a jump? Anyway, I hope it goes away for you!

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4 hours ago, Blahblah said:

Yeah it's very weird. The chest pressure/breathing thing is scary. I've been on a higher dose in the past and didn't have that side effect. But then again,  when you have a break from a med and start up again, it can often affect you differently the 2nd time. Feeling a bit better, but maybe the med has worn off, I tend to feel worse right after I take it in the morning.

I also wonder why at lower Lamictal doses, titration is 25mg per week, whereas, my pdoc upped it immediately from 100mg to 150mg. Seems like maybe too big of a jump? Anyway, I hope it goes away for you!

My pdoc also wanted me to go from 100 to 150 mg, after I was on 100 mg for a few weeks. 

I hope things go well for you as well ! 

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The more mg's you take the larger a leap in dose you often can take. More than 75 mg change and I was effected. 

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On 5/10/2019 at 11:40 AM, lisa2712 said:

Also, I feel LTG acts different on me at different doses. For example, when I was titrations up from low doses (25 mg, 50 mg) I had episodes where I felt like I couldn’t breathe. I’d wake up in the middle of the night almost crying because I felt like I couldn’t breathe. As I got to 100 mg, my body adjusted and I stopped having that side effect. So, I wonder if I went to a higher dose, 175 mg or 200 mg, if my neck tightness and pain would subside, or if my body would get used to it.  

You and everyone else. Until 150 mg every dose change brought a new side effect with insomnia as a constant. Then I hit 150 mg and it all went away. Poof. I still got insomnia for a week or so after changing the dose but otherwise no side effects. 

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5 hours ago, notloki said:

You and everyone else. Until 150 mg every dose change brought a new side effect with insomnia as a constant. Then I hit 150 mg and it all went away. Poof. I still got insomnia for a week or so after changing the dose but otherwise no side effects. 

I was taking 175 mg and the only side effect I had was increased tiredness, where I had to nap for 1 hour during the day, and I still felt tired , day and night. Now, I am going to try taking 150 in the AM, and 25 mg at night, for a total of 175 mg, seeing if it will take away the constant tiredness side effect at 175 mg.

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Good idea. Keep in mind if you take estrogen it will reduce the level of Lamictal by 50 %, it is cited in the PI as a warning. If your BCP contains a week of dummy pills your Lamictal level will double for that week. So you need to titrate based on symptoms and results, not some arbitrary number that works for the general public. 

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