Mental Health Lamictal (lamotrigine) and suicide ideation

[a dream]

I've been taking lamotrigine for the past month and a half and have been taking 100 mg for the past two weeks. I'm depressed, and being treated as bipolar because SSRIs made me "manic". Since the dose was bumped to 50 mg four weeks ago, I've been finding it hard to enjoy anything in life and have been bored almost all the time. At 100 mg these feelings have only gotten worse, and I've been thinking about suicide a lot... My psychiatrist's response was to increase the dose to 150 mg. But then I read reports of others who had the same experience, and found that suicide ideation is noted in the PI sheet.

From the PI sheet:

5.4 Suicidal Behavior and Ideation
AEDs, including LAMICTAL, increase the risk of suicidal thoughts or behavior in
patients taking these drugs for any indication. Patients treated with any AED for any indication
should be monitored for the emergence or worsening of depression, suicidal thoughts or
behavior, and/or any unusual changes in mood or behavior.

Since reading this I have decided to stop taking the drug, which will take a few weeks since the dose has to be reduced slowly. Knowing it's probably just a drug effect made the suicidal thoughts go away, since I now am looking forward to being off the drug. I'm going see my psychiatrist and tell her my decision on Monday. I think it's clear she's run out of ideas, and I think I'm going to try to get her to prescribe a few more things or get referred to someone more experienced.

Does anyone else have a negative experience with this drug? Does my conclusion seem right? I'd never had such strong thoughts of suicide before taking this drug, and felt less depressed before taking it.

 

[neversickanymore]

I would say your conclusion is rite on. I have BP 2 and have good results on lamictal and on lithium.. If you have not tried lithium, I would recommend talking about this option with your dr. WAY TO STAY INVOLVED AND IN CHARGE OF YOUR HEALTH!!!

 

[herbavore]

I think that your conclusion seems absolutely right on and furthermore, I am thrilled that the suicidal ideation has been lessened simply by making that decision. You are listening to your mind, spirit and body in unison and that is always a good thing. I hope that you can find a more humane, creative and willing psychiatrist. What do you think about the roots of your depression? Is it chronic, but without any apparent cause, or have you suffered traumatic events? (Feel free to PM me if that is too personal for this thread but you would like to share).

 

[a dream]

Thanks for the replies.

I would say your conclusion is rite on. I have BP 2 and have good results on lamictal and on lithium.. If you have not tried lithium, I would recommend talking about this option with your dr. WAY TO STAY INVOLVED AND IN CHARGE OF YOUR HEALTH!!!

I was on lithium for a month and it didn't help. The side effects were too much. I don't think I'm really bipolar - but am being treated as if I am because I've acted (hypo)manic on SSRIs (three different ones). I'm not sure if that's the right thing to do, but I once read an academic paper that says bipolar treatments can be effective on patients who become manic on regular depressants.

I think that your conclusion seems absolutely right on and furthermore, I am thrilled that the suicidal ideation has been lessened simply by making that decision. You are listening to your mind, spirit and body in unison and that is always a good thing. I hope that you can find a more humane, creative and willing psychiatrist. What do you think about the roots of your depression? Is it chronic, but without any apparent cause, or have you suffered traumatic events? (Feel free to PM me if that is too personal for this thread but you would like to share).

I'm only seeing a nurse practitioner, and I imagine she'll have me talk to a real psychiatrist now. Lamictal and lithium were her last ideas.

Depression is chronic, without any apparent cause, has been there since childhood. I don't really get enjoyment out of anything (except sometimes temporary novelty from new things), am not really interested in relationships of any kind. It seems worse when I don't have any goals/anything to look forward to - there's nothing I want enough to work towards it. I was actually feeling less depressed a few years ago, when I was living in a place I didn't really like and had a stressful job - because I was looking forward to moving some place better. Now that I have moved and got a better job, I'm actually more depressed.

Besides a few months on SSRIs in college, I didn't really seek treatment until last year.

 

[paranoid android]

I think you are right about the lamictal. I am bipolar and i take lamotrigine and get great results from it but suicidal idealation is a possible side effect of any anti-convulsant or any psychiatric drug. Basically every psych drug besides benzos carry this warning.

There are lot's of other options and it's just a matter of finding the right drug which can be very frustrating to say the least. Like neversickanymore said i would recommend trying lithium if you haven't already. I have not tried it but it seems like a more effective drug for bipolar then say valproate (depakote, epival, etc) or carbamazepine. Not to mention the fact that these drugs are anti-manic drugs and not true mood stabilizers as they don't help depression and can make it worse. Lithium and lamotrigine are the only 2 true mood stabilizers.

Other options would be atypical anti-psychotics such as seroquel, zyprexa, abilify, risperidone, etc. Seroquel can help depression and i have found it to work better for depression then for mania. I also take bupropion which is a norepinephrine and dopamine reuptake inhibitor. It has the least chance of causing mania out of all of the commonly prescribed anti-depressants as it doesn't touch serotonin. It really does help with the godawful sluggish depression and it sort of wakes your brain up. Or atleast that's what it does for me.

Don't give up on finding the right meds. I know it's a bitch but you will find the right meds to help you.

 

[a dream]

Other options would be atypical anti-psychotics such as seroquel, zyprexa, abilify, risperidone, etc. Seroquel can help depression and i have found it to work better for depression then for mania. I also take bupropion which is a norepinephrine and dopamine reuptake inhibitor. It has the least chance of causing mania out of all of the commonly prescribed anti-depressants as it doesn't touch serotonin. It really does help with the godawful sluggish depression and it sort of wakes your brain up. Or atleast that's what it does for me.

I've been on zyprexa before (due to hallucinations) and it was too sedating. Anything that makes me sleep more or reduces energy levels seriously impairs my ability to function. I'm supposed to take abilify but I just stopped, because I want to use psychedelics again. Plus I don't see the need for antipsychotics since I think the psychotic symptoms were temporary and have since passed. The only potential benefit antipsychotics have for me is that they keep me from using certain other drugs.

Wellbutrin is the only psych drug that has helped more than it hurt (excluding short term drugs like stims and benzos). Without it I'm not sure if I'd ever get anything done.

Don't give up on finding the right meds. I know it's a bitch but you will find the right meds to help you.

I think I'm about to give up on pharmaceuticals (except bupropion). I don't expect to get prescribed anything that will actually make me feel better without making me unable to function. But I'll see after my next psych visit.

 

[herbavore]

Depression is chronic, without any apparent cause, has been there since childhood. I don't really get enjoyment out of anything (except sometimes temporary novelty from new things), am not really interested in relationships of any kind. It seems worse when I don't have any goals/anything to look forward to - there's nothing I want enough to work towards it. I was actually feeling less depressed a few years ago, when I was living in a place I didn't really like and had a stressful job - because I was looking forward to moving some place better. Now that I have moved and got a better job, I'm actually more depressed.

Besides a few months on SSRIs in college, I didn't really seek treatment until last year.

Existential depression is an epidemic in modern culture. For myself, I have found that exploring it openly as such, and seeking out all the writing and thought that others are doing to address this, has been the most helpful. Buddhist thought in particular has been the most powerful and freeing for me.

 

[a dream]

I saw my psychiatrist today, told her I no longer felt suicidal because I figured that Lamictal was causing it, and she didn't disagree and had no problem with stopping the drug. So if I was right I should be feeling a little better after I'm done tapering off.

 

[Swimmingdancer]

I don't think I'm really bipolar - but am being treated as if I am because I've acted (hypo)manic on SSRIs (three different ones). I'm not sure if that's the right thing to do, but I once read an academic paper that says bipolar treatments can be effective on patients who become manic on regular depressants.

Perhaps some people are missing this part, that you are not actually diagnosed bipolar or have symptoms of bipolar normally. I had a psych who prescribed me Lamictal to take prior to starting and alongside an SSRI simply because I have a family history of bipolar, (even though I have only ever had bipolar-like symptoms as an adverse drug effect or during drug withdrawal). It is not uncommon for Lamictal to be prescribed for people who have manic reactions to SSRIs. However, there are other drugs for depression that just SSRIs! Many doctors seem to think of SSRIs as the gold standard antidepressants for whatever reason but everyone is different and there are a lot of people for whom SSRIs simply don't work, or worse, cause adverse side effects for.

I didn't find the Lamictal helpful. I think lithium is generally more effective for the mania in bipolar than depression, it doesn't surprise me that you didn't find it helpful. I am kind of surprised that your nurse practitioner seemed to think your only options were either an SSRI or else monotherapy with solely a mood stabilizer normally used for bipolar. There are plenty of other antidepressants, such as SNRIs, tricyclics and tetracyclics, MAOIs (not a first choice due to the need for food restrictions), and various "atypical antidepressants", which don't fit in one of the main categories, for example bupropion (Wellbutrin), a selective dopamine and noradrenaline reuptake inhibitor (DNRI). A GOOD psych should be able to assess all your symptoms, your history and reactions to previous drugs and be able to suggest a med or combination of meds for you to try with a better likelihood of efficacy and lower likelihood of side effects, but of course it's still trial and error. I think asking to be referred to someone more experienced is a very good idea.

You sound kind of like me in that you sound very sensitive to adverse psychological side effects from certain drugs. Have you tried any non-drug approaches for your depression?

 

[a dream]

A GOOD psych should be able to assess all your symptoms, your history and reactions to previous drugs and be able to suggest a med or combination of meds for you to try with a better likelihood of efficacy and lower likelihood of side effects, but of course it's still trial and error. I think asking to be referred to someone more experienced is a very good idea.

I think that's what I need to do. But I don't really have the patience to try new drugs anymore. Ineffective psych drugs have cost me more in time and money than the problems they were prescribed to treat.

You sound kind of like me in that you sound very sensitive to adverse psychological side effects from certain drugs. Have you tried any non-drug approaches for your depression?

I'm doing CBT which, while effective so far, is going slowly. I also made significant life changes that I thought would make me feel better, but actually had the opposite effect since I no longer had anything to look forward to.

 

[Swimmingdancer]

^Surely you can think of more goals and dreams, more things to look forward to?

 

[a dream]

I only look forward to short term things like getting drunk/high and the next season of Arrested Development. My long-term outlook is unnecessarily bleak, and I'm hoping CBT will help with this.

 

[geoffreychaucer]

I have a theory that non-depressed people, who seem motivated and optimistic, spend far less time thinking about and analyzing the future than those of us who are depressed. In other words, these non-depressed people live more in the moment. So the fact that you are motivated by short term pleasures and not by the distant future may not indicate anything unusual. People with depression might just be thinking too hard about what life might be like later in life and projecting their feelings. This is just what I am coming to believe while facing the exact same emotions that you describe in regards to long-term outlook. PM me if you want to talk more about it.
-geoff

 

[Swimmingdancer]

Well if one's only motivators are things like getting high and watching TV that's not exactly healthy. Personally I think that the ideal would be finding a balance between living in the moment, being ok with the present and not obsessing over/excessively worrying about the future, yet still considering the implications of the choices you make (like the potential consequences of doing/not doing things, for example if I literally just lived for the moment with no regard for my future I would never have quit drugs), while still having aspirations and goals for the future and taking steps to make them more likely. I haven't achieved this yet but that's what I am working towards

a dream - I hope the CBT is helpful for you. Some CBT therapists incorporate mindfulness techniques which I think may be key in what geoffrychaucer was getting at.

 

[a dream]

So after a week on a lower dose of Lamictal I've felt less suicidal. I think Lamictal-induced boredom/anhedonia was the cause of my feelings. I haven't thought about killing myself all week, except for earlier today. Some progress, but something is still wrong.

 

[herbavore]

Glad to hear that things have eased up, if only incrementally. Do you live where you can get out into nature at all? I find that forcing myself outside in a natural place like the beach or the woods also forces me to engage with the world outside of my own thoughts, whereas going outside in the city or even just in my neighborhood often compounds my sense of depression. Do you find this is true for you?

 

[a dream]

Getting out helps but it's very difficult for me to get myself to leave my apartment. The best way I can force myself to do things is to go far away for a while, where I'll feel guilty if I spend a bunch of time in a hotel room.

 

[8ball1234]

Haven't tried these meds my doc put me on abilify right away after BP diagnosis due to paranoia and delusional thinking and other things I don't want to get into but at first I was skeptical because he said I was BP and gave me a antipsychotic. Well it turns out it works as a mood stableizer as well and IME has work pretty well finally stable but that was after being off all the other meds we were trying for anxiety and other things.

Taking it one step at a time I learned is very important I could have been stable months ago but I persisted in treating my other symptoms when my doc said he wanted to treat the bipolar and psychotic symptoms before anything else. Man I shoulda listened to him oh well at least I'm stable now and have my kpins for anxiety it all turned out ok.

Now to treat my other symptoms without self medicating with meth going to be hard quoting that shit but as long as whatever he pulls out works then I'm all game

 

[a dream]

I've taken Abilify on and off and found it gives me too much akathisia. Any positive effect doesn't seem to last for long. I was also taking Adderall for ADHD at the same time.

I started taking Lamictal again a month ago, once I finally realized that bipolar II is probably a correct diagnosis. I'm titrating slowly this time and haven't noticed the same numbness yet.

 

[8ball1234]

Yea abilify with other meds has some effects luckily I don't get that side effect but I've heard that it does subside after a month or so. And abilify has taken months and months for me to notice some of the benefits like the reduce of paranoia and for the bipolar it took pretty much a year. I haven't tried another mood stabilizers so I don't have any expierence with them but as for illicit drugs have lots of experience.