Mental Health What's a good Replacement for Lamictal (Monotherapy for Bipolar II)?

[CSM25]

Hello.

I have taken lamotrigine (generic) and now Lamictal (16 days). I think I should probably quit it, despite the fact that it has had some clear positives.

It does help reduce my anxiety and depression significantly. It seems anxiety, social anxiety is a lot less. I just began 50mg and expect the antidepressant effects would be much improved at 100-200mg. Not sure I can last that long.

I think it works better than the generic I tried last year. But, it is also causing side effects. Dizziness and nausea have mostly subsided, but water retention/ edema is there. And some tingling in my extremities. Some pain/dry or perhaps burning eyes are bothering me a bit (not the crazy rash -SJS, I'm hopeful).

Anyways what else is there? I have ADHD and would rather not add 3-5 drugs for the depression (more prominant than my hypomania). I spent more time towards the negative pole, and my hypomania is not too destructive most the time.

I take ADHD medication so I'd like to avoid MAOI's. I reacted badly to the SSRI/SNRI's (which makes sense without a mood stabilizer).
I thought about gabapentin, but that may be hit or miss. Lamictal really does seem to "lift" my depression, and I imagine it would be better at a higher dose, but I'm not sure if I'm going to get into much worse side effects.

At least three times I had a rash, usually "looks like red pen marks". This occurred a couple hours after taking a dose. Itching, no rashes the last several days. I do have burning/dry eyes and tingling/sensation in toes, feet, fingers (last 2 days).

It kind of sucks, because I feel like with lamictal + dexedrine I could maybe almost be functional/normal. But the side effects freak me out. I didn't realize how jacked up I was with previous medications until it was too late. I feel almost "level", at times on this med.

I don't want depakote, seroquel, nor lithium carbonate. CBZ sounds even worse. I wonder what else there is?

 

[AlphaMethylPhenyl]

Lamotrigine has a pretty distinct, unique profile.

Have you contacted your provider about these side effects? They may just be part of your body getting used to the medication, and might pass.

Perhaps they might also be due to something else. Qualified websites such as the Mayo Clinic list side effects of medications.

Gabapentin isn't really supposed to be used for bipolar. At higher doses it's sometimes used for anxiety. For depression, it's not really useful, as far as I know.

Again, tell your provider everything you're telling us, in even more detail if possible. If you're going to float the idea of a medication, though, do it as objectively as possible, and if your doctor doesn't want to do it, I'd leave it at that.

When you say "don't want", you mean that you gave them a significant trial-run before deciding, yes?

 

[Cotcha Yankinov]

Definitely tell your provider about the rashes and other symptoms.

Any particular reason why you don't want Depakote?

 

[CSM25]

Sorry, been a while. I don't want depakote because I lost 70lb as a teen. I was obese... and I've been "in shape" the last 11 years except when on an SNRI (Effexor XR) and an AAP seroquel. I'm getting surgery to correct a tiny amount of excess skin - and I can't afford to gain weight due to meds. I quit lamictal at 28 days because of crazy amounts of water retention, even though it made me lose weight. Its one of the least likely to make a patient gain weight - and I didn't this time around. But, the fluid retention was so bad that it looked like I was quite fat even though the months surrounding lamotrigine (Sept) and brand name Lamictal (Jan-Feb), I've been in the best shape of my life thanks to intense training and diet.

The rashes were pretty benign (11% of people according to some studies and FDA adverse event reports seem to get benign rashes -obviously its hard to tell though).

I had eye twitching, like blepharospasm. Fluid retention, more shakes/tremors - difficulty writing, photosensitivity, a sore/dry/burning eyes sensation but that just became dry eyes and around 14 other affects. Side effects were there when I raised the dose but most went down after about a week. BUT, focus, attention, mood, happiness, "stability", feeling in control, slowing down my writing and talking (pressurized speech), slowing down my thinking (racing thoughts) were all benefits even at only 25-50mg. And It ended a depression in like 2 weeks. I THINK many side effects would go eventually - but I really don't want to mess with hair and weight/body image.

I know one has to accept SOME side effects - but I am trying to fix that skin issue. I think trileptal, tegretol (worse probably), and maybe lithium (with some thyroid med) are the way to go. Unless some natural Medicinal marijuana + inositol works. I am trying to get a card for MMJ - although in Canada -- you can get it anyways. Perhaps the more controlled "medical" strains can help me get relief on the racing thoughts, bipolar depression, and such without the side effects of crazy meds... I won't hold my breath.


Ho-Chi-Minh;


"When you say "don't want", you mean that you gave them a significant trial-run before deciding, yes?"


Not really. I mean I DID give lamotrigine 1 month last winter and 1 month this January-February. I was on Seroquel for reasons unknown to me, when I was 20-21. Either it was for sleep issues, or my former psychiatrist and psychologist (same lady) saw I was going out of control due to Effexor and changed my diagnosis from Generalized Anxiety Disorder to Bipolar... or something else -- I don't know because I can't recall, that was the worst year or so of my life.

Regarding CBZ I fear blood cell, hypothyroid, other side effects. Lithium I fear thyroid effects also, and kidney issues. I'd try them but I just went from 1 med or so - asthma to adding ADHD stuff, now the Lamictal and some hair stuff. The more drugs/meds the worse right? Polypharmacy scares me.

On Lamictal:
-I felt almost normal and my anxiety was greatly alleviated and my depression was disappearing and I felt like I could be happy in life and have better relationships and succeed. I have the intelligence and the skills - but I have a lot of obstacles. And maybe I need med but I don't think I can deal with side effects, unless I'm lucky and find something I can tolerate better. I don't want to need a med, but I don't want to waste my life either. I feel like I'm screwed without treating ADHD. But then without treating BP, I must still be screwed. It's like 0-30% functional vs 40-50% functional vs 80-90% functional (Treating both), but its easier said than done.
-My doctor that diagnosed BP said "we are having two different conversations." And on Lamictal my (different doctor, mostly for ADHD) said "this is the calmest I've ever seen you. We are having the same conversation now, and I can follow you.") So I really am conflicted and don't know what to do.

 

[paranoid android]

Lamictal worked well for me but i had to get to 200mg's a day before it really started working well for both the Depression and Mania. If your getting the rash definitely talk to your doctor asap.

As for a replacement there really is nothing like Lamictal because it's chemically different then other Mood stabilizers/anticonvulsants. I would not recommend Gabapentin as it has been shown to work less well then placebo. Also from my own experience it worsened my depression and made my mood swings worse. I tried Depakote and i found it to be pretty useless. I didn't get any effect off it good or bad. Have you tried any Atypical anti-psychotics such as Zyprexa aka Olanzapine or Seroquel aka Quetiapine? I found Zyprexa to work great as a mood stabilizer as it helped both the depression and Mania and it works within 20 minutes if you get the Zyprexa zydis.

 

[CSM25]

Hi thanks for the responses. I quit Lamictal and I couldn't stand some side effects, but I felt happier than I can remember feeling. It was hard to quit for that reason. But it interferes with some other goals I have (namely what it was doing to my metabolism/ physical fitness). In research I found nothing similar to Lamictal.

Paranoid Android: The lamotrigine then Lamictal were my first and only treatment for my Bipolar II. I recall being on Seroquel at some point between the ages of 19-21. I am not sure why because it was a crazy year and probably my only prolonged severe manic episode - life was truly stressful but memory problems, "bipolar" and "adhd" (both unknown at the time) made it way worse. Maybe my old doctor then at my previous university - saw me acting erratic on Effexor XR and put me on it? Or maybe it was because I mentioned sleep deprivation, insomnia, and sometimes hearing voices (I'm fine there --- that's rare and they don't tell me to do things).

I feel kind of broken. Like I won't succeed in life without ADHD meds. And I won't be happy without treating bipolar / treatment resistant depression (whatever the hell).

I have been trying a HIGH CBD strain of MMJ. It has helped, but not quite like I felt on Lamictal. It is 17%CBD to 7% THC. I want to see the THC decrease and CBD increase. There are (largely anecdotal) reports of people with even more severe problems than I having success on it: Like PTSD, Bipolar I with Psychotic Features. Not to denigrate them, but I just feel hopeful if it helped them it could help me.

Previous cannabis use usually made me have extreme racing thoughts, paranoia, severe anxiety. CBD is much better, but I need higher CBD and less THC. I have 17% CBD and 7% THC now, much better than the Indica I tried which was 9:7 or so (caused "Couch lock" -- not super functional).

I had eye twitching blepharospasm when you close one eye. The rash (probably benign), tremors increased, but it eased anxiety tons and ended depressions each time I went on it. I can't negotiate hair loss or weight gain/ physique changes - as vain as that may seem. It will make me more depressed... I know stability is important but maybe I just don't tolerate meds. I worry because I doubt I tolerated seroquel... this Lamictal is supposed to be the safest. I see people have gained hella weight on depakote and stuff.

I'm lucky that stimulants help me act like there's semblance of control in my life and help depression a bit. Lithium I think is more for Bipolar I. I am more dysphoric, depressed, and agitated than say "high" in general and when I'm hypomanic. Lamictal actually made those more euphoric, but I "seemed high" to a friend that came to meet me one day. But I had just switched night dosing to mornings. Anyways, I felt more positive than I have in a long long time... and if there were just a few less side effects, and I wasn't worried about an upcoming surgery.... I'd stay on it.

But, I may not be able to get the surgery/ have a career and such without some help. Any chance this CBD stuff might be for me? Is there a chance wellbutrin and dexedrine can be taken? i don't want to lose dexedrine as it helped the most with my ADHD. I don't want to set off mania (as I ruined my life the first severe episode.
I seem fairly stable to most ppl, but I have so much nervous energy and don't really see the good in things and catastrophize a lot, and am constantly racing to catch up in life, where i should be already in terms of achievement. And that anxiety and the crushing losses that have happened play out again and again in my head. I focus on what I don't have and NEED... or I focus on "just getting things done." I can fake smiles here and there... but i actually did smile on Lamictal. Maybe after my surgery I'll be happier... but I feel like I can't make the right decisions about my career, life... nor enjoy day to day so far.

-Is it possible Trileptal or Tegretol will help the depressive side of things? Can I just quit them if side effects arise once in a while.
-Lithium orotate a waste of time?

 

[CSM25]

How come I feel almost happy on Lamictal but its less so on Mylan lamotrigine and Apo-lamotrigine (supposed to be a good generic)? Or does that "happy" feeling last only a couple days?
I'm trying Apo-lamotrigine because it's Lactose-free. I think maybe that was adding to the water retention but not solely responsible for it.

Maybe that will go away with more working out, but I remember working out like crazy on Effexor and getting fatter and fatter, despite being skinny any other time in the last 12 years OFF meds. I haven't gained weight on brand name lamictal or on apotex, but I still have the water retention issue. And it isn't imaginary nor due to diet or exercise. Once I get in shape - I stay in shape mostly for at least 4-6 months. I can see definition in my upper half of body, and my legs, but my stomach is distended on mylan-lamotrigine, Lamictal, and I'm guessing Apotex. I lost weight immediately yet look bloated in my stomach - its fkn nuts.
My school is being moronic and not getting back to me: They owe me a 4 year degree. They have to get me back in my program first, and they're taking their sweet time. I'd like to ignore that and the pending surgery... but its very hard and just focus on getting a job, but want to be "stable" on a med if it will indeed help me.

Also, I'm concerned about taking so many blood thinners: Dexedrine, Nicotine (going to quit vaping), Lamictal, and Fish Oil.

I'm on 50mg of apotex lamotrigine.... I quit after two days and started again today. I don't know what to do. Has anyone with bipolar felt that they couldn't live a "normal" productive life, until they got on their meds? I don't get this, I'm smart and not lazy... but I'm super depressed. I have to delay my surgery and its maybe too much to start a med like Lamotrigine, and start a job... find out what the hell to do with my life all at the same time. How do I know if this med will benefit me more than hurt me? I feel lost still.

 

[MrRoot]

Hi,
I suffered through various (hypo)manic and depressive episodes before even getting help and it took quite some time to get right drugs. I was on Lamictal for a while but had to discontinue as it caused rise in liver enzymes.

Been on Abilify (aripiprazole) since then and no (hypo)manic episodes for years but had dealt through some depressive episodes. It doesn't actually in my opinion stabilize the mood but more kind of prevents manic episodes which often lead to depressive episodes and leaves your mind into more unaltered like state than for example Lamictal, which made me feel pseudohappy.

Looking back to my past when I was not diagnosed and thus not medicated I would not wan't to go through the same as I did. I had some weird career choices such as becoming a peace keeper and getting wounded in Afghanistan and I also selfmedicated (ahem. abused) myself with stimulants (mild, such as Ritalin) and benzos and sleeping pills.

Got also addicted on oxycontin but that is another story and more related into spinal injury I have than to a bipolar disorder.

 

[TensionClown]

I've been on lamictal for years and the first they told me was to discontinue immediately if I develop a rash (which I didn't). Have you told your doc about the rash? As far as how it works; it has worked pretty good overall for me for my bipolar symptoms. I was on depakote first and that stuff was terrible, imo. I gained 50 lbs before I told them to give me something else. I have a new doctor now who is questioning my bipolar dx and I have started to ween off the lamictal which has not been easy. Just some things to consider based on my experience. Hope it helps and please watch out for that rash.

 

[CSM25]

Thanks for the replies. I don't know if I have bipolar either. But I do have chronic low moods and at the very least "treatment resistant depression".
I kind of want the lamotrigine. I haven't been on it much - only 27 and 28 days before. I quit each time. My latest one was a version with no lactose - I believe it helped with stomach issues and
produced less swelling. But it still made my hair shed like crazy. I lost a lot of hair on adderall, then maintained it on dexedrine, and lost more on lamotrigine. Now I'm on finasteride.

Can finasteride counter the hair loss from both meds? Assuming its drug caused and also I have the genetic tendency for hair loss? Many male relatives do have major hair loss, and others don't. On my Mom's side and Dad's side. It looked like I was safe - I don't have a pattern, it still looks full with no recession, but I have a lot of diffuse thinning.

I don't want to be "more balanced" and have hair loss among other problems. I kind of want to try 6 months no dexedrine and just use medical marijuana and CBD oil (from a licensed medical marijuana producer) but I don't know if it will keep my mood up all day. I wake up sad or very depressed at times and other times just unable to get my things done, because I don't really know what to do. I need to figure it out soon and get work. My rashes seemed to be mild and not that kind of rash, and they never stayed. Should I ask for Trileptal or will it be the same? DO doctors put their kids on any of this? If I only had ADHD, and I had a son who was like 18... and clearly had it, and was struggling I think we would consider it strongly, but the rest? Are fucking scary to me and damaging. I seldom had life altering affects from real drugs.

 

[hydroazuanacaine]

be very careful about medical marijuana. i am consistently diagnosed with bipolar ii. i don't take medication for it and am struggling. marijuana makes it much worse for me. but it makes me feel very relieved in short term. everyone is different. i relate to your symptoms so wanted to share for your consideration. i am also consistently diagnosed with some sort of intrusive thought ocd, to fully disclose any possible differences.

sorry to hear you are suffering. you have my empathy and best wishes.

 

[AlphaMethylPhenyl]

i am consistently diagnosed with bipolar ii...marijuana makes it much worse for me. but it makes me feel very relieved in short term.

This is the trend I've seen and lived over the years. Things seem great while actually high, then coming back to reality you find things harder to bear.

 

[Mmp85]

My doctor took me off lamictal and Effexor and gave me Latuda.
I take depakote and I've been able to maintain my weight after losing the weight I'd put on from a variety of meds.
I wouldn't avoid depakote for that reason alone.

 

[CSM25]

Should I try Lithium Carbonate?
I tried Trileptal 2 days - I am not sure I guess it stopped some racing thoughts but made me feel sluggish and kind of sick. And maybe more depressive. Maybe with an antidepressant it'd be fine.

I am trying lithium orotate. I think that whether I have BPII or ADHD and treat one or the other is kind of irrelevant, because it may as well be a combined condition and I should address them together, but I'm really scared and I don't want to fuck up my life more. I think that relationships, schooling, work, everything including depressions would be less long lasting if I addressed this "bipolar/bipolar depression part." But I keep getting burned by meds.

Is it possible to get by on say 300 or 450mg of Rx Lithium and (usually 10-20mg) 10-30mg Dexedrine? Just like I was briefly combining Lamictal 50mg (75mg once reached) and Dex at same time?

Maybe I'm "mild" bipolar, but it does cause serious cognitive problems in conjunction with my ADHD... but maybe I don't need a hefty dose of Lithium. Maybe some people respond to AAP's and have less side effects than they do on AED's, and some respond to and tolerate AED's better than Li+, or some respond/tolerate Li+ better than AED's and AAP's. It's trial and error right?

Is it always worth it to treat bipolar? Or can radical situational things change everything? Completion of my surgery, full-time work, and pursuing my true passions can help.. But I may need the "tools" which is what meds are for, right? I can't reconcile between meds being helpful despite their shortcomings and meds being poisonous. I really don't want to waste more time. I was so full of life as a kid, and I loved people and wanted to be so many things, and I don't want to die alone struggling between some illness that may or may not exist and meds that I either "need" or eventually come to rely on with acquiescence. I don't want my paradigms to shift again - like where I thought I had an Anxierty disorder and "I needed my EFFEXOR" and it destroyed my life, so quickly. I don't want to get benefit but also more damage. If this is all real, how come it took like 8 years to get "correct" diagnosis? Why's it so hard to get adequate treatment?

 

[CSM25]

I shouldn't have tried anything. Hair ruined by lamotrigine. And around 20-25 side effects of Finasteride. Including muscle, collagen, facial fat loss. So instead of looking good (that and personality and intellect basically are the only sources of confidence I had)...I'm fucked. Considering following Cdsnut's protocols on Swolesource.... I can't believe it. I was doing well. Living alone, nice place, finished uni... was about to work, travel, and be myself. Had to try and treat my "BPII"... and that made me get on Finasteride. I may have autoimmune or bad reactions, due to epigenetic changes. Haven't I suffered enough with Effexor and the like. I could have just gotten a hair transplant in the future. AND seen friends, or screamed or drank or smoked... not taken lamotrigine. I fucked my life up. And I want out.