Arj72 Posted July 10, 2019 Share Posted July 10, 2019 Hi all, I’ve been on lamictal for the past 15 months or so. Right from the beginning, it was helpful for depression after I fought through the initial titration but I had always dealt with insomnia and agitation on it. We tried to augment with lithium with little success and had a good few months on seroquel, but always, the agitation remained. We’ve tried many iterations of combinations with AAP’s, but none have been successful completely. Has anyone had this reaction to lamictal (constant agitation that doesn’t go away)? I want to experiment with coming off of it, but am afraid to return to depression as well. Kind of at a loss on what to do. Link to comment Share on other sites More sharing options...
argh Posted July 10, 2019 Share Posted July 10, 2019 Are insomnia and agitation related? Causing one another? Link to comment Share on other sites More sharing options...
Arj72 Posted July 10, 2019 Author Share Posted July 10, 2019 2 hours ago, argh said: Are insomnia and agitation related? Causing one another? Not sure. I’m back on seroquel at the moment which is largely taking care of the insomnia, but the agitation remains. Link to comment Share on other sites More sharing options...
browri Posted July 12, 2019 Share Posted July 12, 2019 What are your daily doses of Seroquel and Lamictal? Link to comment Share on other sites More sharing options...
argh Posted July 12, 2019 Share Posted July 12, 2019 There are case reports that lamotrigine can cause hypomania. It supposedly does have effects on serotonin much like and antidepressant. Link to comment Share on other sites More sharing options...
browri Posted July 12, 2019 Share Posted July 12, 2019 43 minutes ago, argh said: There are case reports that lamotrigine can cause hypomania. It supposedly does have effects on serotonin much like and antidepressant. They do mention this in literature that lamotrigine has a VERY modest affinity for the serotonin transporter and the 5HT3 receptor acting as an inhibitor and an antagonist respectively. It isn't generally believed to be clinically siginificant, but lamotrigine is dosed so high and has a relatively longish half-life that you gotta wonder.... Link to comment Share on other sites More sharing options...
Iceberg Posted July 12, 2019 Share Posted July 12, 2019 Agitation is listed as a 1-5% side effect on medscape Link to comment Share on other sites More sharing options...
notloki Posted July 13, 2019 Share Posted July 13, 2019 The only time I experienced agitation was during the titration period. Once I got to a stable dose it went away. Based on the posts here these are symptoms to be expected during titration. Link to comment Share on other sites More sharing options...
argh Posted July 13, 2019 Share Posted July 13, 2019 On 7/10/2019 at 12:52 PM, BusuB said: Not sure. I’m back on seroquel at the moment which is largely taking care of the insomnia, but the agitation remains. What is your dose? Maybe this is breakthrough agitation or hypomania and you just need more? Link to comment Share on other sites More sharing options...
Arj72 Posted July 13, 2019 Author Share Posted July 13, 2019 18 minutes ago, argh said: What is your dose? Maybe this is breakthrough agitation or hypomania and you just need more? I spoke to the doctor yesterday. He actually suspected the quel moreso than the lamictal. He said he’d seen a manic switch in one of his patients before. Even pushing it to 800mg made it worse. Switching to vraylar now. Hoping it has more anti-manic properties. Link to comment Share on other sites More sharing options...
argh Posted July 13, 2019 Share Posted July 13, 2019 4 minutes ago, BusuB said: I spoke to the doctor yesterday. He actually suspected the quel moreso than the lamictal. He said he’d seen a manic switch in one of his patients before. Even pushing it to 800mg made it worse. Switching to vraylar now. Hoping it has more anti-manic properties. Ah. Good luck dude Link to comment Share on other sites More sharing options...
Arj72 Posted July 13, 2019 Author Share Posted July 13, 2019 For everyone, I had pushed to 225 lamictal from 150. Also on 300 quel. Doc felt it was more the quel and the change in season that was pushing me up. Quel did well in the winter but not during the summer I guess. ive switched to vraylar and keeping the lamictal on board. Doc gave me diazepam to help with the transition. He offered clonazepam but I feel like diazepam is smoother. Link to comment Share on other sites More sharing options...
Iceberg Posted July 13, 2019 Share Posted July 13, 2019 How much/how fast on the Vraylar? for what it’s worth I had a much lower level of agitation type symptoms with Vraylar than with seroquel Link to comment Share on other sites More sharing options...
Arj72 Posted July 14, 2019 Author Share Posted July 14, 2019 23 hours ago, Iceberg said: How much/how fast on the Vraylar? for what it’s worth I had a much lower level of agitation type symptoms with Vraylar than with seroquel Standard 1.5 mg day one and then 3 mg after that. So far, minimal side effects though I’ve been hiccuping a lot. Apparently it’s pretty rare and I’m hoping it passes soon (happened to me on Abilify too). No effect on mood yet and the diazepam is doing a number on the agitation. Feeling.... not bad. Link to comment Share on other sites More sharing options...
browri Posted July 15, 2019 Share Posted July 15, 2019 On 7/13/2019 at 11:24 PM, BusuB said: Standard 1.5 mg day one and then 3 mg after that. So far, minimal side effects though I’ve been hiccuping a lot. Apparently it’s pretty rare and I’m hoping it passes soon (happened to me on Abilify too). No effect on mood yet and the diazepam is doing a number on the agitation. Feeling.... not bad. I'm currently starting on Vraylar now too. If you find you have any tolerability issues, my pdoc told me it may be good to do 1.5mg every other day for the first two weeks, then increase to 1.5mg every day for another 2-4 weeks, then increase to 3mg if necessary. Vraylar is definitely activating, but in a different way from Rexulti and Abilify (having personally tried taken all three at this point). Point is that Vraylar has a really high rate of akathisia for an atypical antipsychotic, and going to 3mg quickly can sometimes cause really bad akathisia. However, I see you're also prescribed diazepam, which will certainly help to keep that under control. The long half-life means that it's really easy for a pdoc to increase the dose too fast and ultimately have to decrease it later because of tolerability issues like akathisia or EPS. And the diazepam may be covering that up. I'm taking clonazepam with Vraylar right now and I'm going into Week 4. Did the first 10 days 1.5mg every other day and now on my 12th day of 1.5mg every day. It's really really nice actually. Not quite like Rexulti. Not as sedating. I like the activation during the day, but it does keep me very UN-agitated, lol Link to comment Share on other sites More sharing options...
Arj72 Posted July 16, 2019 Author Share Posted July 16, 2019 10 hours ago, browri said: I'm currently starting on Vraylar now too. If you find you have any tolerability issues, my pdoc told me it may be good to do 1.5mg every other day for the first two weeks, then increase to 1.5mg every day for another 2-4 weeks, then increase to 3mg if necessary. Vraylar is definitely activating, but in a different way from Rexulti and Abilify (having personally tried taken all three at this point). Point is that Vraylar has a really high rate of akathisia for an atypical antipsychotic, and going to 3mg quickly can sometimes cause really bad akathisia. However, I see you're also prescribed diazepam, which will certainly help to keep that under control. The long half-life means that it's really easy for a pdoc to increase the dose too fast and ultimately have to decrease it later because of tolerability issues like akathisia or EPS. And the diazepam may be covering that up. I'm taking clonazepam with Vraylar right now and I'm going into Week 4. Did the first 10 days 1.5mg every other day and now on my 12th day of 1.5mg every day. It's really really nice actually. Not quite like Rexulti. Not as sedating. I like the activation during the day, but it does keep me very UN-agitated, lol Roger that. I’ll be sedated for a while as I taper seroquel but so far, I like the vraylar a lot. My agitation is way down, even without the diazepam on board (only needed for 3 nights). With the hypo largely gone now, I’m hoping for more mood brightening effect moving forward. Link to comment Share on other sites More sharing options...
browri Posted July 16, 2019 Share Posted July 16, 2019 13 hours ago, BusuB said: Roger that. I’ll be sedated for a while as I taper seroquel but so far, I like the vraylar a lot. My agitation is way down, even without the diazepam on board (only needed for 3 nights). With the hypo largely gone now, I’m hoping for more mood brightening effect moving forward. Mood brightening may be more at 1.5mg with 3mg being the more calming dose of the two. And of course once you get to 4.5mg and 6mg, those are both mania-only doses. Won't help with depression. Link to comment Share on other sites More sharing options...
saoirse Posted September 17, 2019 Share Posted September 17, 2019 Ohhh yes. I was constantly on the verge of hypomania when I was on Lamictal. Link to comment Share on other sites More sharing options...
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