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What Causes Headache, Sleeplessness And Lack Of Concentration While On Lamictal?
Question: Hello Doctor...continuing questions about Lamictal:
I can definitely link the sad, obsessive, somewhat hostile, "blaming" condition I've had since this summer on the lamictal, so I need to focus my question on this:
I originally started taking it in 2005 in conjunction with my celexa, which was starting to make me impulsive again. It didn't do so much as a mood stabilizer, but it worked wonders for me on parts of my depression that had never been touched before....namely motivation, interpersonal anxiety and self possession. It had a HUGE role in turning my life around and helping me start and maintain a thriving business...at least in conjunction with a smaller dose of Celelxa. I don't feel it had the same effect with zoloft, Viibryd, or Brintellix. Might have even contributed to feelings of lethargy on them.
Knowing this I have a hard decision to make now. For some time now I have been able to link sad, hostile, blaming, and cognitive blunting (or some combination) to the Lamictal...it hits me two hours after taking it. I may need to come off the lamictal altogether, even though it did so much for me 10 years ago.
Last week I left my pills at home and waited until after lunch to take them and I went from feeling great all day to have intrusive suicidal thoughts. Same thing yesterday. I went from having a great day to having these symptoms when I took my early evening dose. (I split them up because taking the entire second dose at night impairs my sleep).
Because of headaches, sleep, and concentration issues I am down to 150mgs now, which I think is at the lower end of the therapeutic spectrum.
Have you seen this phenomenon where lamictal can cause these symptoms or "turn" on a patient after many years of exposure? Or perhaps that it has a negative effect until reaching a certain dose and then becomes more positive? I don't remember having these experiences when I was at 200 or above but the other side effects were getting in my way.
thanks!
I can definitely link the sad, obsessive, somewhat hostile, "blaming" condition I've had since this summer on the lamictal, so I need to focus my question on this:
I originally started taking it in 2005 in conjunction with my celexa, which was starting to make me impulsive again. It didn't do so much as a mood stabilizer, but it worked wonders for me on parts of my depression that had never been touched before....namely motivation, interpersonal anxiety and self possession. It had a HUGE role in turning my life around and helping me start and maintain a thriving business...at least in conjunction with a smaller dose of Celelxa. I don't feel it had the same effect with zoloft, Viibryd, or Brintellix. Might have even contributed to feelings of lethargy on them.
Knowing this I have a hard decision to make now. For some time now I have been able to link sad, hostile, blaming, and cognitive blunting (or some combination) to the Lamictal...it hits me two hours after taking it. I may need to come off the lamictal altogether, even though it did so much for me 10 years ago.
Last week I left my pills at home and waited until after lunch to take them and I went from feeling great all day to have intrusive suicidal thoughts. Same thing yesterday. I went from having a great day to having these symptoms when I took my early evening dose. (I split them up because taking the entire second dose at night impairs my sleep).
Because of headaches, sleep, and concentration issues I am down to 150mgs now, which I think is at the lower end of the therapeutic spectrum.
Have you seen this phenomenon where lamictal can cause these symptoms or "turn" on a patient after many years of exposure? Or perhaps that it has a negative effect until reaching a certain dose and then becomes more positive? I don't remember having these experiences when I was at 200 or above but the other side effects were getting in my way.
thanks!
Brief Answer:
There is no such phenomenon that at certain point the effects become +ve
Detailed Answer:
Hi, thanks for asking again
I can understand your concern and would like to tell you that Lamictal or Lamotrigine is a good mood stabiliser drug. The drug help in stabilisation of mood especially in patients of bipolar depression and thus helps in depressive symptoms also. The drug is over all a safe drug and is free of serious side effects except headache and sometimes in some rare patients serious rashes.
The effects you are experiencing with this drug are different than the typical side effects. I haven't seen these effects to my patients. What doses are you taking right now?
Though risk of side effects remain high in higher doses, but I don't think to a particular dose the drug results in negative effects and then at higher certain dose the drug results in more positive effects. Such type of phenomenon might be seen in initiation of therapy but on long term such effects are not seen particularly.
Thanks. Please mention what doses are you taking right now?
There is no such phenomenon that at certain point the effects become +ve
Detailed Answer:
Hi, thanks for asking again
I can understand your concern and would like to tell you that Lamictal or Lamotrigine is a good mood stabiliser drug. The drug help in stabilisation of mood especially in patients of bipolar depression and thus helps in depressive symptoms also. The drug is over all a safe drug and is free of serious side effects except headache and sometimes in some rare patients serious rashes.
The effects you are experiencing with this drug are different than the typical side effects. I haven't seen these effects to my patients. What doses are you taking right now?
Though risk of side effects remain high in higher doses, but I don't think to a particular dose the drug results in negative effects and then at higher certain dose the drug results in more positive effects. Such type of phenomenon might be seen in initiation of therapy but on long term such effects are not seen particularly.
Thanks. Please mention what doses are you taking right now?
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I have been up as high at 300 or more miligrams before. I was at 200mgs and I first noticed the issue when I went below that.
Brief Answer:
This could be due to some unknown mechanisms.
Detailed Answer:
Hello again,
I guess this we have discussed earlier also. Lamictal is a mood stabiliser drug that causes changes at receptor levels and when the receptors are activated it results in action. There is no specific therapeutic levels for this drug and the drug shows its response even in low doses also.
But in some newer studies it has been found that Lamotrigine may have therapeutic window phenomenon, but further studies fail to confirm this. Relation between drug concentration in blood and pharmacological response has not been established. So, I might be wrong but I don't expect any significant difference in responses with 200 or 300 mg doses. Most likely this is due to psychological issues and not the pharmacological issues.
Thanks, I hope this reassures you. Still have more doubts please don't hesitate to ask again.
This could be due to some unknown mechanisms.
Detailed Answer:
Hello again,
I guess this we have discussed earlier also. Lamictal is a mood stabiliser drug that causes changes at receptor levels and when the receptors are activated it results in action. There is no specific therapeutic levels for this drug and the drug shows its response even in low doses also.
But in some newer studies it has been found that Lamotrigine may have therapeutic window phenomenon, but further studies fail to confirm this. Relation between drug concentration in blood and pharmacological response has not been established. So, I might be wrong but I don't expect any significant difference in responses with 200 or 300 mg doses. Most likely this is due to psychological issues and not the pharmacological issues.
Thanks, I hope this reassures you. Still have more doubts please don't hesitate to ask again.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor:
The biggest effect I got from the drug was antidepressive and anxiolytic--not really as a mood stabilizer. Please read what I wrote above.
I have heard people say that that "brain fog" feeling or just "zoning out" has to do with a flood of neurotransmitters in your brain. It may have even been you who said that taking a small amount of klonopin could clear up the cobwebs.
Well last week I decided to take a full .5 mgs of klonopin before bed before feeling too desperate and avoiding the holidays. I also starting using lightbox therapy to help mood and sleeping cycle.
What I experienced was a remission from the daytime agitation and depression, a lack of overwhelming rumination and blaming; no suicidal ideations; and no cognitive drop-offs that I was experiencing before. I also felt emotionally much more open.
What does this suggest to you? I know .5mgs Klonopin is a small amount, but I do feel a little "comedown" in the late afternoon where I feel very sensitive to outside factors, then a craving for alcohol. I noticed if I take a late afternoon dose of lamictal IT DOES INITIATE THOSE ANGRY/BLAMING SYMPTOMS I MENTIONED ABOVE!!! I tried it several times just to check and I can tell you this is true!
The biggest effect I got from the drug was antidepressive and anxiolytic--not really as a mood stabilizer. Please read what I wrote above.
I have heard people say that that "brain fog" feeling or just "zoning out" has to do with a flood of neurotransmitters in your brain. It may have even been you who said that taking a small amount of klonopin could clear up the cobwebs.
Well last week I decided to take a full .5 mgs of klonopin before bed before feeling too desperate and avoiding the holidays. I also starting using lightbox therapy to help mood and sleeping cycle.
What I experienced was a remission from the daytime agitation and depression, a lack of overwhelming rumination and blaming; no suicidal ideations; and no cognitive drop-offs that I was experiencing before. I also felt emotionally much more open.
What does this suggest to you? I know .5mgs Klonopin is a small amount, but I do feel a little "comedown" in the late afternoon where I feel very sensitive to outside factors, then a craving for alcohol. I noticed if I take a late afternoon dose of lamictal IT DOES INITIATE THOSE ANGRY/BLAMING SYMPTOMS I MENTIONED ABOVE!!! I tried it several times just to check and I can tell you this is true!
Brief Answer:
Various mechanisms for the response
Detailed Answer:
Hello again and thanks for asking a follow up question
The quick and positive response with Klonopin occurred most likely due to anxiolytic and some mood stabilising properties of the drug. If we consider psychopathology of mental disorders then the reasons why mental disorders occur are multifactorial and there is no specific cause for mental disorders. Similar thing applies for response to drugs. The drugs act through various mechanisms like blocking of Serotonergic, Dopaminergic receptors. Newer theories also include Glutamate, GABA receptors roles in symptoms. The reason why I am mentioning this is that though Clonazepam is an anxiolytic still in some newer studies the drug has been found to have antidepressant and this could be the reason for the response. The drug also potentiates the actions of the other drugs also. You can take the drug in divided doses like 0.25 mg one in morning and one in afternoon and this will improve the late afternoon worsening of symptoms also.
Thanks, Still not clear or have more doubts please ask again.
Take care
Various mechanisms for the response
Detailed Answer:
Hello again and thanks for asking a follow up question
The quick and positive response with Klonopin occurred most likely due to anxiolytic and some mood stabilising properties of the drug. If we consider psychopathology of mental disorders then the reasons why mental disorders occur are multifactorial and there is no specific cause for mental disorders. Similar thing applies for response to drugs. The drugs act through various mechanisms like blocking of Serotonergic, Dopaminergic receptors. Newer theories also include Glutamate, GABA receptors roles in symptoms. The reason why I am mentioning this is that though Clonazepam is an anxiolytic still in some newer studies the drug has been found to have antidepressant and this could be the reason for the response. The drug also potentiates the actions of the other drugs also. You can take the drug in divided doses like 0.25 mg one in morning and one in afternoon and this will improve the late afternoon worsening of symptoms also.
Thanks, Still not clear or have more doubts please ask again.
Take care
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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