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Lamictal (lamotrigine) to calm post-discontinuation withdrawal symptoms

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Cdav

cymbaltawitdrawal5600, Sorry to hear the Lamictal caused you that bad reaction. I'm going to be very careful. If I feel anything getting worse, I'll stop. I'm just going to give it a try as I'm desperate to feel a little better. But there's always a possibility of having a bad reaction. 

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cymbaltawithdrawal5600

I really don't know why things worked out the way they did. All I remember from that time is that I started to feel really good off the meds. Some of us who cold turkey have a honeymoon period where we feel the best we have in years as the dulling effect of the meds wears off. But the moon is short-lived. At 5 months DP/DR hit, lamictal never would have prevented it, it is not the drug for that. It was given to me to "regulate my moods" because what was really happening was that the cymbalta was really messing me up, even at the high dose I was on. Nasty drugs those SNRIs are.

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cymbaltawithdrawal5600

And I might add that Alto is probably the one to listen to. My stance right now, after what I have been through, is that more meds are not the answer. In my heart of hearts, I know they don't work and all of them make you feel bad in some way. If not outright ill then blah, sedated, numb what have you. I have lived through the blackest depression I have ever had in my life in the second year off the drugs, I pray it never happens again. But if it does? I'll grit my teeth and go through it again if I have to because on the other side has been some of the sweetest feelings I have ever had, they just came out of the blue for no reason. And oh gosh, I survived all that!

 

I hope you can soon get to that place too.

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Cdav

cymbaltawithdrawl, it's great that you were able to survive without the need of any more meds. 

 

I went to the pdoc today, I asked him about the studies he had told me about. Apparently I was mistaken, these were not studies made on people on antidepressant withdrawal, but on people who once consumed amphetamines and after that they had withdrawal and flashback symptoms. Lamictal helped these people recover and have spontaneous remission from their symptoms. That is why my doctor assumed Lamictal might help me too. He said AD's and amphetamines are not too different from each other in the way they affect neurotransmitters, so that was his logic for using Lamictal with me. But he wants to use a higher dose, 100 mg. Right now I'm on 25 mg and I have tolerated it well. I think I do feel better, the depression has lifted a little bit and I'm having less headaches and less twitching. 

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Altostrata

Your pdoc picked up a good clue from those studies -- lamotrigine tends to slow down activating signal transmission, which might be helpful in amphetamine withdrawal.

 

If I were you, I'd stay at 25mg for a while and see if it works for you. Best to be on the minimum effective dose rather than try to slam all the symptoms down at once.

 

Your nervous system also has to be able to form new, healthy patterns without interference from the drug.

 

As a "brake," lamotrigine can be too much and go paradoxical, which sounds like what happened to cw.

 

Also, you will need eventually to taper off lamotrigine.

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Cdav

Alto, yes, I think my doctor is good at doing research and understanding prolonged WD. 

 

Lamictal was working really well until PMS hit me. Hormones can really mess up everything when combined with an already unstable nervous system. 

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Cdav

Alostrata, 

 

you said that too much Lamictal could become paradoxical. 

 

I followed my doctor's instructions (probably not a good idea) and updosed the Lamictal from 25 to 100 mg during the last 3 weeks. Last weekend I started feeling very dizzy and unbalanced and on Monday I started feeling a lot of akathisia with restless legs (I also took Sam-e for 3 days but the akathisia has continued after a week of stopping it). After an infection this week I also had to take an antibiotic and the akathisia got worse. 

 

My question is, do you think Lamictal can be causing the akathisia/restless legs and body? My doctor is not sure about this, he thinks it might still be the discontinuation syndrome in general, since I've had it before (when not taking Lamictal) But this time it's been much more intense. 

 

I think this might be the lamictal, I'm going to try to lower the dose to 25 mg again and see if this was the trigger. 

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Altostrata

btdt, I hid your post because it is completely off topic. Please respect the original intention of any topic.

 

Cdav, that's a big increase in lamotrigine. Jumps in lamotrigine dosage are dangerous. Yes, it could be causing a paradoxical over-stimulation. Was 25mg helping? If I were you, I'd go right back to it.

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Cdav

I'm not sure if 25 mg lamictal were helping I was still very depressed. Not sure. I think depression improved a little when updosing to 100 mg but physical discomfort increased. I also recently went on an antibiotic and antihistaminic for a sinus infection with high fever. They probably iinteracted as well. I'm going to drop lamictal to 50 mg and see if the physical symtpoms improve. I really think it was heping depression, but maybe 50 mg will still help.

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Altostrata

What are your physical symptoms?

 

I don't think lamotrigine does much for depression. It's calming; in excess, it's stupefying.

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LoveandLight

Is it possible to take lamictal while still on antidepressant?

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Cdav

Love, I think it is possible. Doctors often give them as a combo. As long as you tolerate Lamictal. 

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Altostrata

They are often prescribed in combination, but I don't know why you'd want to do that. If you are tapering too fast, lamotrigine is not likely to make up for it.

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Altostrata

And there are possible interactions....

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Cdav

Lamictal did make me feel very foggy and weird and then it went paradoxical on me when updosing and caused akathisia, so be careful Love. 

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LoveandLight

I'm not tapering ATM..trying to stabilise after a very fast taper..and getting increasingly desperate.

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LoveandLight

In micro-doses it could help withdrawal syndrome but not if still on the drug?

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LoveandLight

I'm still confused about possible micr-dosing with lamictal. I'm going to give it a few more months to stabilise but is the idea of micro dosing here only once the person is off the main drug that caused the WD? Thanks.

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oskcajga

This is an article that has propagated all over the Web, by someone named Altostrata. It has been updated for this post:

 

As I've been suffering from Paxil withdrawal syndrome since October 2004, I've studied the medical literature on antidepressant withdrawal syndrome. What I've learned about the alerting system and glutamatergic system in antidepressant withdrawal syndrome may be informative.

 

Antidepressants cause downregulation of serotonin receptors. In a mechanism of brain self-defense, the receptors actually disappear, becoming more sparse so as to take in less serotonin. It is thought among withdrawal researchers that people who experience the worst withdrawal are slower than others to repopulate serotonin receptors.

 

Others believe those who suffer the worst are those whose brains are highly neuroplastic and adapted more thoroughly to the influence of the medication.

 

Relative slowness to upregulate receptors doesn't mean there's anything intrinsically wrong with our brains, it just means there's variability (of course) among nervous systems.

 

Even among people suffering the most severe antidepressant withdrawal syndrome, repopulation of serotonin receptors probably occurs long before symptoms disappear. However, while the serotonin system is repairing itself, an imbalance occurs in the autonomic nervous system. The locus coeruleus "fight or flight" center becomes disinhibited and the glutamatergic system becomes more active than normal. This is called disinhibition of the alerting system, and it generates symptoms that are awful: panic, anxiety, sleeplessness, and dreadful imagery among them.

 

This paper explains the mechanism in withdrawal causing alerting disinhibition: Harvey, et al: Neurobiology of antidepressant withdrawal: implications for the longitudinal outcome of depression; Biological Psychiatry. 2003 Nov 15;54(10):1105-17.

 

Once disinhibition of the alerting system takes hold, it becomes self-perpetuating. The whole question of neurotransmitter imbalance -- a chimera of psychiatry anyway -- becomes moot. No manipulation of serotonin, norepinephrine, or dopamine is going to help. In fact, it usually makes the condition worse.

 

Noradrenergics -- buproprion or Wellbutrin; mirtazapine or Remeron; SNRIs such as Cymbalta, Serzone, Effexor; and St. John's Wort, rhodiola -- stimulate "fight or flight" activation, as will most SSRIs. Drugs and substances that are stimulating should be avoided.

 

Even drugs that are calming may cause a paradoxical reaction as the alerting system fights to stay in control.

 

My guess is: The first phase of withdrawal, the acute phase, is the initial shock of withdrawal, with the most defined symptoms, such as brain zaps and nausea. The second phase is when the serotononergic receptors are repopulating, with waves of depression and anxiety. The third phase is when glutamatergic hyper-reactivity and autonomic instability take over. Often the autonomic instability causes wide hypersensitivity to drugs, supplements, and even foods.

 

Out of control, unrelated to environmental or psychological triggers, the alerting system sends intense, spontaneous signals to the adrenals, which produce the stress hormones cortisol and adrenaline.

 

This is not strictly brain damage. Brain damage means some physical part has been permanently removed and can never be recovered. Rather, this is iatrogenic neuropsychiatric damage.

 

According to established principles of neuroplasticity, the nervous system can repair itself and regain functioning that is close to normal. In cases where there is no apparent iatrogenic cause for autonomic dysfunction, it often spontaneously resolves. Low stress, good nutrition, and as much sleep and gentle exercise as possible are key.

 

[ironically for those suffering from lamotrogine (Lamictal) withdrawal -- too-fast Lamictal withdrawal causing glutamatergic rebound -- lamotrigine is a drug that tempers the activity of the glutamatergic system, incidentally reinforcing an intact GABA system. Microdoses of lamotrigine can assist recovery from antidepressant withdrawal syndrome. I am being treated with about 5mg per day and it is helping me recover.

 

Cautionary note: Lamotrigine may not be a universal treatment for withdrawal syndrome. If you want to try it, make sure you consult a doctor who is very familiar with using it and start with very small doses -- .5mg to begin, slowly titrate up to 5mg or more; stay at the lowest effective dose. Nausea and headaches are signs of too high a dose. (2mg tablets are available by request from GlaxoSmithKline; 5mg tablets are available by prescription; lamotrigine can be made into a liquid by a compounding pharmacy.) In too large a dose, lamotrigine, like everything else, can make your symptoms worse.]

 

In the medical literature on antidepressant withdrawal, symptoms of alerting system disinhibition -- anxiety, panic, sleeplessness, irritability, agitation among them -- are sometimes misidentified as "unmasking" or emergence of bipolar disorder. This leads the clinician to medicate with a cocktail of drugs upon which the patient does poorly, the neuropsychiatric damage from antidepressant withdrawal being compounded by additional medication and attendant reactions.

 

In Anatomy of an Epidemic, Robert Whitaker describes this process as the way many children, suffering adverse effects from antidepressants, are led into a lifetime of medications for misdiagnosed bipolar disorder.

 

It's always the victim who's blamed, not the drug. It's about time we took a closer look at what withdrawal does to the nervous system, and question whether the chronic downregulation of serotonergic receptors caused by long-term antidepressant prescription is a benign condition.

 

If you're really desperate, you could just go to a doctor and claim bipolar symtpoms, get a prescription of lamictal, buy a fine scale that can measure in the mg doses (this would probably cost you at least a couple hundred dollars), and then split the pills yourself.  This is obviously risky, and I don't suggest it, but I'm just saying you don't NEED a doctor to do this.  If you're given 12.5mg, just crack it apart until you can find a .5mg dose and just keep using that same pill for a long period of time.  If hte doctor gets suspicious, just switch doctors and rinse and repeat. 

 

 

If anyone here cares to know, I personally found some relief by taking a moderate dose of adderall.  This is obviously a long term problem, because you'll go through hell getting off the adderall again, but I found 5-10mg of adderall to help me function during the day in a job environment.  This is more of a band-aid over a hemorage sort of fix, but it does work if you're desperate. 

 

If you are to attempt using adderall to see how it helps you, I'd try starting at 1.25mg instant release and then going up from there.  Again, I wouldn't suggest this strategy though, because adderall is really addicting and after the first coupe of weeks you won't feel very good anymore and will absolutely need the pills to do much of anything.  But if you're in a desperate situation and trying not to lose your job or something like that, you might want to ask your doctor for a small dose of adderal instant release and see if it helps.  I got panicky at night when it was wearing off, so you will probably want to be very careful about the dose and not start at anything very high, anticipating the anxiety at night, but it sure can help in some short term cases.

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Altostrata

The information in this topic is in regards to taking lamotrigine to reduce symptoms after going off drugs, not to add lamotrigine while taking another drug.

 

The best way to minimize symptoms while tapering is to control the rate of taper of the drug, not to add another drug such as lamotrigine.

 

I have moved posts discussing lamotrigine from One theory of antidepressant withdrawal syndrome to this topic.

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Altostrata

oskcadjga, what symptoms did Adderall help and how did you feel while you were on it?

 

Please note: Adderall is an amphetamine. If your withdrawal symptoms are of the alerting type -- surges of anxiety, tension, sleep problems -- a stimulant such as Adderall (or even caffeine) is likely to make you worse.

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Altostrata

From another topic:

 

 

I'm really worried about how this information is being misinterpreted.

It seems people are peeking in from the Internet on smartphones, failing to read the whole topic or even the entire first post, and thinking they can add Lamictal or something to their tapers to compensate for withdrawal symptoms.

DON'T DO THIS!!!!!! Don't count on being able to take a pill to fix whatever is wrong with you.

Anything you add may conflict with something you're already taking.

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oskcajga

oskcadjga, what symptoms did Adderall help and how did you feel while you were on it?

 

Please note: Adderall is an amphetamine. If your withdrawal symptoms are of the alerting type -- surges of anxiety, tension, sleep problems -- a stimulant such as Adderall (or even caffeine) is likely to make you worse.

 

 

Adderall allowed me to function without really noticing the ssri withdrawal effects as much.  It amps me up so much and gave me so much energy that it elimated much fatigue, and gave me the energy to work hard to overcome some of the brain fog.  It did NOT cure my cognitive problems, or the trigeminal nerve porblems, tingling numbness, etc, but it gave me the energy to basically work around them at will.  It also sort of helped with the anhedonia, by giving me some sort of dopamine boost and making me feel "vaguely motivated and pleasurable".

 

Anxiety was less during the 8 hours or so of adderall in my blood (I took ~10mg of adderall XR, and then a 2.5 mg "boost" around 12PM to keep the high going until 5pm pr so) but then doubled at night until it was totally metabolized.  The discomfort and anxiety as adderall was wearing off was really unpleasant, I'm glad I don't have to deal with that anymore.

 

the ONLY reason I stopped adderall was because I refused to pop amphetamine pills for the rest of my life.  I'm sort of an idealist in that sense, because I could have saved myself from a lot of pain and suffering if I didn't get off of adderall.  I'd also certainly have a job at this point and not be sitting on a dwindling bank account in my parents basement.  But the fact that I don't take any medication at all right now, and tend to be slowly improving, is more worthwhile to me than holding down a job and being a SLAVE to adderall.  I definitely underestimated the severity of adderall withdrawals, as I'm still recovering and it's been around 8 months now since my last pill.  Mostly just not motivated, and fatigue, and cognitive issues, not nearly as horribly debilitating as SSRI withdrawal.

 

It's been hell getting off of adderall, that's why I really wouldn't recommend taking adderall unless its some sort of dire situation that warrants making your brain chemistry more dysfunctional in the long run at the benefit of giving you the energy to overcome seemingly hopeless odds.  So if you're trying to support 3 children and keep a job while going through ssri discontinuation, it MIGHT (no real guarantees) help for a while.  In my case, it is the only reason I was able to writing a competitive dissertation in spite of the profound congnitive problems.   I was able to take it 5x per week for around 1 year without any massive loss of adderal's effectiveness.  The only thing that went away was the dopamine high after the first couple of weeks, and the other change I noticed was my absolute and utter reliance on adderall to do anything at all.  Long term adderall use basically made me like 30-50% more effective overall while I was taking it, but like 200% less effective when I wasn't on it during the weekends. 

 

The key with taking adderall is to obviously 1)  take just enough and 2) don't abuse it.  People that abuse adderall chase the bliss that they experience for the first 1 week or so, before your body downregulates dopamine receptors.  

 

Also if you take adderall daily for a while, you'll probably not be able to do anything at all when you're not taking it, making your life incredibly more difficult during those periods. 

 

Definitely not a magic bullet.

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Hangingon

Wish I had happened upon this before reinstating Prozac 1 mg, then added quetiapine 6.25 mg to help w severe WD that kicked in after final taper of cocktail Of ssri,snri,gabapentin,trazedone and benzo (tapered off 23 months)

I'm still in severe protracted WD.

So it's my understanding that I can't take the lamactil w these drugs? Or that it won't be effective or will cause harm?

Would like to discuss this w psych doc.... Go off Prozac 1 mg and quetiapine and try lamactil?

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Altostrata

Sorry, I have no idea how your plan would work. Most doctors cannot fathom very low doses of lamotrigine and force people to take too much, thereby causing adverse reactions to it.

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stan

when we put in google what is lamotrigine, we have :

 

New process for the Preparation of 6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamine

 

and when we put triazine, we have :

 

As a chemical family, the triazines are a group of pesticides with a wide range of uses, used to destroy grass for example...

 

and in pubmed we have :

 

[Lyell syndrome and Stevens-Johnson syndrome caused by lamotrigine].
[Article in French]
Abstract
BACKGROUND:

Lamotrigine is a new anticonvulsant belonging to the triazine family. Several cases of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) have been described in patients taking this drug. We report 2 cases in children attending the same hospital.

CASE REPORTS:

Two children, aged 9 and 13 years, developed SJS and TEN respectively, 3 and 28 days after lamotrigine was added to their usual anticonvulsant regimen. In both cases, outcome was favorable despite major decline in psychomotor capacity in one. In the first case, chronological attributability was plausible for lamotrigine and doubtful for sodium valproate, clonazepam and hydrocortisone. In the second case, chronological attributability was probable for amoxicillin, plausible for lamotrigine and doubtful for sodium valproate, but the numerous previous absorptions of amoxicillin made lamotrigine more suspect.

DISCUSSION:

The risk of Steven-Johnson syndrome and toxic epidermal necrolysis is high with lamotrigine with an estimated frequency of 1/1000. This risk is probably higher than with other anticonvulsants. Associating lamotrigine with sodium valproate increases the frequency of adverse skin reactions.

 

components of mood stabilizer , antidepressants, benzos are chemical toxics from oil ... used by manufacturer to paint, to stick, to burn etc 

 

maybe they will help "withdrawal" ? why not...we have to try, hopefully there exist doctors who are specialist , so all is fine

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oskcajga

You'd have to go to a doctor and tell them that you feel bipolar, and just lie to them about taking the meds and collect the 25, and 50mg tablets and then just stop going.  If you get a jewler's scale you can just crush the pills and get a lot of doses out of that visit. 

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Altostrata

Stevens-Johnson Syndrome affects people who are taking too much lamotrigine, or when the dosage has been increased too fast. It has been seen most often in children because their bodies are smaller and less able to metabolize higher dosages.

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alwayslookup

Just wanted to do a "quick poll" of asking everyone who is also on a micro dose of Lamictal.

 

How does it seem to help you?

Your experiences of when to take the dosage or dosages (if you split the dose)?  

 

Thanks ;)

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tntd

I know this is an old thread but I was wondering if Lamictal a micro dose of Lamictal would help with anxiety and agoraphobia. I am housebound.

 

I developed anxiety and agoraphobia when I CT'd buprorpion but I am currently tapering clonazepam. I am looking at tapering the benzo for years due to my CNS being so sensitive due to the CT. I noticed while reading the thread it was said not to take if you are tapering. I have the complex situation of a CT and all the hyper alerting from that CT along with trying to taper a benzo. I have spoken with my dr about the micro doses and he is willing to let me try. I am planning at starting at .5 mg but after reading this thread I'm not sure if I should since I am still taking a benzo. 

 

I am going to taper the benzo using a symptoms based taper as cutting even tiny amounts (2.5% was my last attempt and I've held for over three weeks now) sends my sxs flaring and I become non-functional. 

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Altostrata

Rather than adding a drug and its potential side effects, we recommend slower tapering of the benzo. If you feel this is impossible, your guess is as good as anyone's whether a microdose of lamotrigine would help.

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tntd

Thanks Alto,

 

I've been tapering my benzo at a glacial speed. In three months I've only been able to taper off 5.8% while having horrible w/d sxs and having to hold a lot. At least I'm going in the right direction :)  I'm just desperate to be able to leave the house as I've had severe agoraphobia for eight months. I'm looking at a four to five year taper at least if I can't taper any faster, and I am having a hard time reconciling myself to being housebound that long. I do realize that the lamotrigine may not help at all which is why I'm trying to gather as much information as possible before I make my decision. 

 

Thanks for your response. I really do appreciate your time. 

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woof

My doctor has just recommended lamictal to me to help me withdraw from Valium.  He does understand about about low dose tx.

 

However, I asked him about the addictive aspects of lamictal and withdrawal and he assured me that it was not addicting.  WTH?

 

I suppose this just another case of us needing to take care of ourselves to a large extent.

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