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Lamictal (lamotrigine) to calm post-discontinuation withdrawal symptoms

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Phil

ADMIN NOTE: Read One theory of antidepressant withdrawal syndrome before reading this topic.

 

For information about titrating lamotrigine, see Tips for tapering off Lamictal (lamotrigine)


 

Has anyone else tried Lamictal to treat withdrawal symptoms and did it help? I ask because I have seriously been considering it, as my depersonalization is so horrible. It seems that a few people on depersonalization forums find it helpful too. I am extremely wary of ANY psych drug now, but I need some kind of hope of getting better. Depersonalization is the one w.d symptom that depresses me the most.

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Maybe

Hey Phil,

 

To be honest, I would never again touch any psych med. Even if other people say it has helped them, you never know if it will bring you relieve as well. On the contrary, it might even worsen your situation or prolong the wd.

 

But that are just my two cent.

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Barbarannamated

Phil, I believe the DP effects me most, also. It's very hard to describe and makes it extremely tough to interact w anyone. I can chat superficially w strangers, but I'm distant from anyone who knows me aside from one friend. He seems to be the only one able or interested to break thru the bubble I feel like I'm in.

Does any of this resonate w you?

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Phil

I understand, Maybe. I'm the same, terrified of meds. But my situation is so bad now, I am so incapacitated that I'm considering the Lamictal. Things are so bad I get suicidal thoughts because I can't imagine living this way for god knows how long.

 

Barbara - oh god yes that really resonates with me. I feel like I can talk on "autopilot" but I cannot say anything about how I feel, apart from with my one close friend, and even then he gets fed up of my moaning.

 

I went to see a singer perform live tonight and I was so anxious and depersonalized, it was horrible. Just hellish.

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Altostrata

Phil, you're not off Lexapro yet, is that right?

 

About Lamictal, here's the problem: Not many doctors know how to use Lamictal and recognize when to increase and when to decrease dosage, plus how it's affecting the withdrawal symptoms. They also don't understand the hypersensitivity issues and insist on doses that are far too high to accomplish what we want -- to support the nervous system in healing instead of inducing yet another drug-dominated state. Some people report bad reactions to doses of Lamictal that are too high.

 

For some people with a different variety of withdrawal syndrome, taking lamotrigine may not be the right approach.

 

Here are a few tips about using Lamictal that I learned from my doctor. I'm not an expert and I don't know how this would be applied to any particular person:

 

- Dosages are individual, need to be started at very low amounts, and slowly titrated up.

 

- He starts everyone out at 2mg or less. Because I was so hypersensitive, he started me on .5mg. He likes to give a dosage a try for 4 days to see how it works, get beyond initial wooziness, etc.

 

- The trick is to find exactly the right "sweet spot" for your nervous system. At one time, I started at .5mg, went up to 2.5mg, backed down again to 1mg, eventually settling at 1.07mg. In a second phase, I titrated up to 5.4mg. (I am currently tapering off.) Now, someone else's optimal dose may be 24.3mg or 38.2mg or 10.1mg.

 

- For someone with withdrawal insomnia, the "sweet spot" is a dosage at which sleep is increasing towards normal and side effects are negligible.

 

- Lamictal does increase GABA somewhat while decreasing glutamatergic transmission. However, the GABA system needs glutamate to make GABA so too much Lamictal will have a paradoxical effect -- you don't want to go too high.

 

- Signs that you're taking too much Lamictal: Queasiness or headache (or both), sleeplessness, agitation.

 

- Initial side effects can be wooziness, grogginess, sleepiness, lack of energy.

 

- To firmly establish the newly revived healthy brain patterns, expect to stay on the Lamictal for about a year. He has had patients who went off the medication and were fine, they didn't need to take it anymore.

 

- In severe withdrawal insomnia, deep sleep is the first to go and the last to come back. It's important because human growth hormone is secreted in deep sleep and it is physically and mentally restorative. When deep sleep returns, emotional numbing will lift.

Edited by Altostrata
fixed text

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Phil

Thankyou for writing that Alto, it is very helpful. No, I'm not off Lexapro yet, but I still get horrible depersonalization just after small reductions.

 

I find this interesting:

"He has had patients who went off the medication and were fine, they didn't need to take it anymore."

because some people on the depersonalization forums said a similar thing - they stopped taking Lamictal without any problems, and the gains they made on it remained. Strange to think that a med could actually do that!

 

BTW, what do you mean by "To firmly establish the newly revived healthy brain patterns" ?

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Altostrata

Phil, could you provide a link to this info in the depersonalization forums? I'd like to see it.

 

The low-dose Lamictal reduces the withdrawal-induced alerting reaction (unhealthy homeostasis) so the nervous system's natural functioning can take over and re-establish a healthy homeostasis. This is fragile at first but gets stronger -- as in all healing patterns.

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Phil

Here it is Alto:

 

http://www.dpselfhelp.com/forum/index.php?/topic/19310-lamictal-may-be-helping/

 

Looking back on it, it seems to be just one person who mentioned it, so maybe it's not as reliabale as I implied. Sorry about that. There are other reports on there that it helps though:

 

http://www.dpselfhelp.com/forum/index.php?/topic/29193-has-anyone-here-tried-lamictal-can-it-work-right-away/

 

BTW does this "alerting reaction" involve things like being easily triggered by things in your environment, like noises and such?

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Altostrata

....

BTW does this "alerting reaction" involve things like being easily triggered by things in your environment, like noises and such?

 

Thank you for the links, Phil. (Those people really need to know dp can be a result of withdrawal.)

 

Yes, those are alerting symptoms. There was a time when a phone ring at 6 p.m. would set my alerting system off to the point I wouldn't be able to sleep all night. And, you've seen discussions here about light sensitivity and so forth.

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alexjuice

Oversimplifying, it sounds like I am short serotonin receptors. What about on the presynaptic side?

 

I have noticed that I react to certain substances that some call anti-serotonin. For instance, bone marrow/bone broth causes issues. Coconut oil is the latest one which seems to cause issues.

 

Interestingly, I've heard other substances referred to as anti-serotonin, particularly coffee/caffeine, that have definitely helped.

 

It seems that a good google for "serotonin foods" or "serotonin antagonist food" or "serotonin bone broth" or "serotonin NAMEAFOOD" -- any of a plethora of searches on this theme -- list stuff that affects 5ht processes in some way... And when I consume these items...stuff happens without fail, it is these things that I am very sensitive too.

 

I wonder what strategy to pursue with these foods/drinks? because I can calm myself with ginger tea, I can improve sex function with caffeine... I realize the complications of the issues here... But I wonder, is the crux of my problem on the front end or the back end of the transaction? It seems that i can make more 5ht with the right diet -- or at least create changes in mood/performance that lead me I believe I have.

 

Is it better, I wonder, to use these sensitivities to my benefit for symptom relief or if just better to stop messing with the system, since I want my body to direct a repopulation so I should step aside....

 

I'm not even sure I am being clear and making sense, just thinking.

 

Thinking, acting, feeling, eating, drinking... And waiting for my anatomical response.

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Iggy131313

Shipko advices to se tiny does of lactimal during w/d and of coure David Healy suggests that CCBs can be helpful, they have a similar mechansm dont they? Anway I would lie to addmy own theory here

 

I have obviously done alot of thinking about what the hell is going on and read many many theories around w/d and adverse reaction and here is my lastest and greatest theory...

 

So we know that the serotonin receptors deregulate when taking ssri = this is one of the few facts that we have.

 

We also know that the CNS is shocked and in a damaged or recovering state during this time - we know this for a fact.

 

I now believe it takes the CNS around 18 months to recover from the shock but there are of course other factors and things that will set us back - this usually involves causing further shocks to the cns.

 

Based on my previous theory that being on an ssri med resets he serotonin levels in the same way my breathing centre and oxygen need was reset during my chvs, I think after removing the ssri medication (unless this is done very very slowly therefore adjusting those preset levels) we continue to function in the same way we did whilst taking the meds - this isnt a problem of course because our receptors have not yet grown back,

 

we may have a little shock to the cns and be experiencing physical or milder psychological issues before the upregulation takes place, it depends on the half life of the drug and level of dependancy.

 

I think it takes around 4-6 months for the receptors to grow back, this is when alot of people say the phychological symptoms come on and acute w/d kicks in, this was cetainly the case for me.

 

ssris also I think sedate the cns, now without the sedation of the ssri medication the upregulation of the serotonin recpetors gives us a huge increase in serotonin that we are unable to cope with and brings on all the terrible w/d symptms but also shocks the cns massivly.

 

Those who have had an adverse reaction may start to recover from the cns shock straight away but bt those of us in w/d I believe the saga continues.

 

I think that when the receptors have grown back only to find themselves unable to cope with the serotonin levels again they once again start to downregulate, this can take a couple of months the same as when starting a med perhaps even slower because the serontonin levels may have already started to reset back to normal- however we do not return to normal once the receptors have downregulated again because of the shock to the cns.

 

But perhaps once the receptord have again downregulated and some of the cns shock is recovering this would be when the acute w/d phase ends, I also belive that the receptors would then start to regrow again, taking roughly 4/6 months - the cns is trying to recover during this time and the serotonin levels are trying to find the pre-med balance.

 

so we come to the infamous 11 month - 1 year wave when I believe the receptors have upregulated again and STILL the serotonin levels are too high, perhaps lower than they were but not at a normal level - this would cause yet another wave until the receptors once again start to downregulate, but once again this has given the cns another shock - perhaps milder than the one before but still a shock.

 

I think this pattern continues until the serotonin is at a reasonable level for the upregulated receptors to cope with, each time they upregulate it would bring on a wave and each time they downregulate again a window could appear.

 

of course as I have said I belive that the cns damage is the main thing but that its harder to keep the cns stable when our receptors are growing back time and time again, but I believe that once the serotonin levels are at a point where they are no longer forced to downregulate that the cns REALLY begins to heal.

 

I know its just a laypersons daft theory, and I know it doesnt help or cure anything but for me, it helps to have SOMETHING that makes even a tiny bit of sense.

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Altostrata

Thank you for your thoughts, iggy. Can you clarify these points?

 

What is a CCB?

 

Where does Dr. Shipko recommend minute doses of lamotrigine?

 

Why do you think it takes the receptors 4-6 months to grow back?

 

Why do you think the serotonin receptors downregulate again after growing back?

 

Why do you think the serotonin levels are "too high" post-discontinuation? Too high compared to what?

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Iggy131313

calcium channel blocker, its in his long piece about withdrawal that s posted on here.

 

I know a woman who is a patient of Shipko, he has suggested this to her many times,

 

I am guessing about the receptors taking that time to grow back, going on accecdotal evidence of when the worst wave payyerns seem to happen, also that my w/d kicked in at 5 months after CT,

 

Lte me give some background on my thoughts and they really are only my thoughts.

 

A few years ago I developed adult onset asthma, I left it untreated, I would struggle getting to the end of a road and be gasping for breath. stupid of me to leave it but because it came on out of the blue I kinda thought it would just go away. some months later I began not being able to take a deep breath my lungs would stop as if full. To cut a long story short, I had Chronic Hyperventilation Syndrome, this is not that I would hyperventilate alot but that I had been taking in so much oxygen to try to compensate for the asthma that my breathing centre reset, this led to me constantly trying to get more air than my body needed, I had to learn Buteyko breathing and do certain breathing exercises that would deprove my body of oxygen to reteach the brain that it did not need the vast amount of oxxygen that I was previously giving it. This took 4 months.

 

I beive that ssris do the same, reset the serotonin system to wok at that level and it continues to do so after the removal of the medication, but there are no exercises that can force the serotonin system back to normal levels, the have to do this for themselves and hopefully will do so once the medication is removed, but if It took me 4 months of daily HOURLY exercises to reset the breathing centre then a natural return to homeostasis would take obviously alot longer.

 

Uts this that I am basing my theory on.

 

I think the rece[tors downregulate again because the serotonin is still too high for them to cope with, and may explain why we have the waves at 6, 12, 18 months etc. as I say its only a theory

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Altostrata

The body is full of serotonin all the time, most of it in the gut.

 

Serotonin receptors in the brain upregulate and downregulate all the time to keep this level constant. Think of them as sensor valves.

 

Antidepressants force some of the sensor valves to stay open. The body's regulatory mechanism causes others to close (downregulation or desensitization). The level of serotonin is not affected, only how the sensors read it.

 

After discontinuation, the same amount of serotonin washes over the sensors, but they can't accurately read the level.

 

Gradually, the sensors that still have sensitivity upregulate. The speed of this varies from individual to individual.

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Iggy131313

ah! oh well, like I said it was just a theory and Im so so scred and looking for something that may vive me some comfort in whats going on.

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kerrip

I will say that I am at the 11 month mark and have hit a bad wave. It is milder than previous waves but it does stink.

 

I sure would like to be done with this by 18 months, where did you get that figure from? Do you know anyone whose CNS was healed by then?

 

Has low does lamotrigine really worked for anyone? I have a new PCP who is more receptive to my situation compared to my previous doctor, so maybe I can convince her to consider this.

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Iggy131313

So the real issue in w/d or recovery seems to be the glutamate overpopulation? have I read that right? so does the lamictal reduce the glutamate receptors or does it interfere with the signaling?

 

I read an interesting peice on a benzo board written by a woman who works in a brain scanning area of a hospital and assists with diagnosis....she was saying that in w/d (she was talking about benzos but there seems to be overlaps) the glutamate receptors are too abundant and the TIME it takes to heal is how long it takes for the gaba receptors to return to normal and for the glutamate receptors to downregulate.

 

Is there any drug that can make the glutatmate receptors downregulate? I know there obviously isnt or it doesnt work or we would have taken it and been fine. Just interested and find that if I can try to have SOME kind of understnading and try to take the mystery off this, it becomes less scary. Not that Im not terrified, I am.

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Altostrata

No, it's because the alerting system in the brain is not balanced by a modulating system normally in place. The alerting system sends out signals via glutamatergic transmission.

 

The glutamatergic system is the phone lines, not the message. It's just doing its job. Don't try to upregulate or downregulate glutamate receptors.

 

Lamotrigine decreases the reactivity of glutamatergic transmission.

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Iggy131313

So recovery is the modulating system getting back into place? what is the modulationg system? is it the balance of other hormones like seroyonin and dopamine etc?

 

I know you dont have all the answers alto, but your knowledge is obviusly the best around.

 

Do you think that we have nerve damage and the nerves need to repair themselves?

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Altostrata

That's perhaps the 100th time you've asked those questions, Iggy. Sorry, I don't have time to answer them again.

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alex

I´m having terrible insomnia problems.

 

Can Lamictal help me? Because I´ve read it causes insomnia.

 

Maybe in very low doses?

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alexjuice

I've never taken it. Lamictil is discussed, maybe only briefly I'm not certain, in the Theory thread: http://survivingantidepressants.org/index.php?/topic/392-one-theory-of-antidepressant-withdrawal-syndrome

I believe there is a sttrong hesitation towards advocating of lamictal because it can potentially make things worse and there aren't many doctors who know what they are doing with it. Sorry to here about the insomnia though. Insomnia is a frequent withdrawal symptom that is horribly disruptive.

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Lilu

No, it's because the alerting system in the brain is not balanced by a modulating system normally in place. The alerting system sends out signals via glutamatergic transmission.The glutamatergic system is the phone lines, not the message. It's just doing its job. Don't try to upregulate or downregulate glutamate receptors.Lamotrigine decreases the reactivity of glutamatergic transmission.

Would taking GABA in supplement form help? Instead of Lamictal?

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Altostrata

GABA supplements do not cross the blood-brain barrier. You might get a little muscle relaxation from them (or an adverse reaction), but that's all.

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Exie

my CNS is still seizure-like from tapering imipramine and klonopin so fast more than 5 years ago. lamictal might help but I cant bear it if it'll set back my brain recovery making the mental problems worse. so does lamictal mess up the brain like klonopin too? does it cause mental problems?

and starting at the lowest dose, I dont want to higher the dose (scared to). so if I take it only at the lowest dose, its not possible to taper, right? since its already the lowest dose. so I would just stop taking it, right? like cold turkey. but how long would I need to take it? what is the shortest amount of time I can take it? is it okay to take it only at the lowest dose? or is it necessary to higher the dose? because I'm scared to taper off another med again and go through another withdrawal. is lamictal also addictive? 

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Exie
I've seen that topic before but I dont recall it having the answers to my specific questions, thats why I'm asking here. so lamictal reduces nervous system hyperactivity and alerting which sounds exactly like what I need, but my problems are more from klonopin not the AD. I dont have the antidepressant alerting symptoms like anxiety, racing thoughts,etc. my CNS is physically seizure-like from klonopin, physically shaking/twitching and the seizure movement/neurological pressure in my head. my brain/mental problems are also from the klonopin. my main symptom from the antidepressant is just the food hypersensitivity. but since lamictal is an anti-seizure that sounds like what I need, because my cns is literally seizure-like. but lam is also a mood stabilizer for bipolar so it does affect the brain. you said it helped you recover though so that means it doesn't cause mental/cognitive problems? but then my brain is recovering from klonopin while yours wasn't..so I guess you dont really know if it'll set back my brain recovery.. but if it causes mental problems then it would interfere with my brain recovery.

 

in the topic about Lam, you talked about titrating up, but I dont recall anyone saying if highering the dose is not necessary. do you know if its okay to keep taking it only at the lowest dose? I dont want to higher the dose because that means more tapering.

and the lowest dose to start is 0.5? you said you tapered down to 0.04, is that a too low dose to start at? and is it okay to take it just for a few weeks? or is that too short ?

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Meimeiquest

Exie, I think it is post 30 on the first link Alto gave you in the post just above that you are looking for. I am sorry it is still so hard. No one can tell you how you as a unique person might respond.

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tezza

Lamictal does need to be tapered and smaller doses are accomplished by making a liquid suspension. I think Rhi is making a liquid with hers.

 

I was taking 200 mg before I began tapering. It helps some people but it wasn't a good drug for me. I hope you find the answers you're looking for, I know it's frustrating.

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Altostrata

Here is post 30 (thanks, meimei) http://survivingantidepressants.org/index.php?/topic/392-one-theory-of-antidepressant-withdrawal-syndrome/?p=11585

Used to calm withdrawal symtoms, lamotrigine is very tricky.

  • Too much, you get bad symptoms.
  • Too little, it doesn't do anything.
  • The lowest effective dosage varies from individual to individual.
  • If you go up too high in dose, or titrate up too fast, you can get a dangerous allergic reaction, Stevens-Johnson syndrome.
  • If you don't taper off slowly enough, you can get terrible withdrawal symptoms.
  • Effective use is dependent on the skill of the doctor, and few doctors know how to use lamotrigine.

We cannot take any responsibility if you choose to try lamotrigine for withdrawal symptoms. Experiment at your own risk.

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Lexy

Phil, you're not off Lexapro yet, is that right?

 

About Lamictal, here's the problem: Not many doctors know how to use Lamictal and recognize when to increase and when to decrease dosage, plus how it's affecting the withdrawal symptoms. They also don't understand the hypersensitivity issues and insist on doses that are far too high to accomplish what we want -- to support the nervous system in healing instead of inducing yet another drug-dominated state. Some people report bad reactions to doses of Lamictal that are too high.

 

For some people with a different variety of withdrawal syndrome, taking lamotrigine may not be the right approach.

 

Here are a few tips about using Lamictal that I learned from my doctor. I'm not an expert and I don't know how this would be applied to any particular person:

 

- Dosages are individual, need to be started at very low amounts, and slowly titrated up.

 

- He starts everyone out at 2mg or less. Because I was so hypersensitive, he started me on .5mg. He likes to give a dosage a try for 4 days to see how it works, get beyond initial wooziness, etc.

 

- The trick is to find exactly the right "sweet spot" for your nervous system. At one time, I started at .5mg, went up to 2.5mg, backed down again to 1mg, eventually settling at 1.07mg. In a second phase, I titrated up to 5.4mg. (I am currently tapering off.) Now, someone else's optimal dose may be 24.3mg or 38.2mg or 10.1mg.

 

- For someone with withdrawal insomnia, the "sweet spot" is a dosage at which sleep is increasing towards normal and side effects are negligible.

 

- Lamictal does increase GABA somewhat while decreasing glutamatergic transmission. However, the GABA system needs glutamate to make GABA so too much Lamictal will have a paradoxical effect -- you don't want to go too high.

 

- Signs that you're taking too much Lamictal: Queasiness or headache (or both), sleeplessness, agitation.

 

- Initial side effects can be wooziness, grogginess, sleepiness, lack of energy.

 

- To firmly establish the newly revived healthy brain patterns, expect to stay on the Lamictal for about a year. He has had patients who went off the medication and were fine, they didn't need to take it anymore.

 

- In severe withdrawal insomnia, deep sleep is the first to go and the last to come back. It's important because human growth hormone is secreted in deep sleep and it is physically and mentally restorative. When deep sleep returns, emotional numbing will lift.

 

 

My new doctor started me at 12.5mg of lamotrogine and will increase next week.  I just read this entire thread and concerned that I should start on a lower dose for effexor withdrawals.  Or am I being prescribed a higher dose since I am actually still tapering?

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Altostrata

Please ask your doctor and let us know the answer, Lexy.

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Cdav

I know this is an older thread. 

 

But my doctor made some research and also found Lamotrigine helps people in acute and protracted withdrawal. He said that the studies he found showed that most of the people who showed spontaneous remission from WD, were taking lamictal. 

 

I took lamictal before when I was on AD's, and didn't show an allergic reaction or anything. So he wants to start me on 25 mg and then updose to 50 mg. After reading this thread, this dosage seems enormous. I'm a bit confused. But willing to give it a try. I'm scared to start on this high dose, though. I'm going to call him and tell him I want to start on a much lower dose and see how I feel. 

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Altostrata

I would like to see the studies your doctor found, Cdav. I haven't been able to find any. If you can, please get copies.

 

Good idea to start on a much lower dose than 25mg. Your system may be sensitive to it.

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cymbaltawithdrawal5600

While cdav is waiting for the studies, I had an odd experience with lamictal. After I CT from cymbalta, lamictal and K, the doc told me I could skip the cymbalta (knowing I would never take it again) and just try lamictal. (This was several weeks or so after I had the initial wd sickness and I was still thinking I needed meds.) I started with a 25 mg dose for a week I think it was and then was supposed to increase till I got to my usual dose of 100mg. 25 mg was ok but as soon as I took 50 mg my head started pounding. Same thing the next day. I took my blood pressure and it was not alarming but higher than it had ever been (but not the 170's over 100's that it was in the ER.) I stopped it after 2 doses, told her I was going to go AD free.

 

I believe lamictal initally is prescribed in special packs that allow you to gradually increase (titrate) the dose slowly so you do not get a life threatening rash. I was not given one of those because I had already been on the drug but had been off it for a couple of weeks (memory is hazy) so I still had to go slow. I just said the heck with it, I did not want any more meds and I did not like the fact that my body was reacting with a spike in bp.

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Cdav

Alostrata, I'll see my doctor again next week and ask him if he has a copy of those studies, and see if he can e-mail them to me. If I can get them, I'll send them to you. 

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