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Mental Health Want to try lamotrigine but I'm a little scared

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glab

Bluelighter
Joined
May 3, 2015
Messages
182
I want to try Lamotrigine for depression and my pdoc agreed but I'm scared of the steve johnson syndrome.
This stuff looks really scary. I don't even know what to do or how to behave if I start with lamotrigine and then I
get a rash. What do I do then?

Another thing which worries me is how well does lamotrigine mix with other prescription drugs like antidepressants,stimulants
and maybe supplements like tyrosine,alcar,glycine,caffeine.

What if there are interactions which aren't known yet cause nobody researches them? The last thing I need is to be scared all the
time that I could get some interactions.

What also worries me is that I heard that lamotrigine can make your memory worse. When I was trying out lyrica I was also afraid and
thought my memory was getting worse and then I got off it cause it was just too risky. As a student I cannot afford this. :(
 
I'm under the impression that only a very small minority of people get the rash.

If you find yourself with the rash, most doctors would simply direct you to stopping the medication. Titrating up slowly may reduce the probability of getting the rash.

In the end, little to no harm can come from you trying it, right?

You should ask the doctor if it would mess with treatment or not to take those supplements. As for the other medications, hopefully all your medications are managed by one person. They should be aware of any risks related to such a combination.

While medications are tested by themselves, it's a sad fact that combinations of medicines rarely are. The testing in this sense comes from it being prescribed. I looked up how long Lamictal has been on the market for psychiatric reasons, and it looks like it's been around in this sense for over ten years. That's a long time. It's likely that the medication regimen you're prescribed has been prescribed at least thousands of times before, so if there is significant danger, chances are mental health professionals are already aware of it.

Some people find themselves with side effects only after learning that such is a side effect. It happens all the time, unfortunately.

All kinds of adverse symptoms can manifest from any medication. It's certainly possible that you could experience it giving you a poor memory, but you'll never know if you don't simply take what you're prescribed.

Maybe ask your doctor what the first sign of the rash looks like.
 
hi, what got me worried in the first place is that i read in book about psychopharmacology which is only available in german that sertraline must not be mixed with lamotrigine because it interferes with the metabolization of
lamotrigine and this causes toxic byproducts. (i also made a thread about this on the forum).
But the thing is that not even Stephen Stahl mentions any of this in his books!
But it's mentioned on drugs.com, too. Why is such an important interaction not mentioned? Is it still relatively unknown? I don't know. But it's really unsettling cause if sertraline can do this
then who knows what other antidepressants or other drugs can do the same and then you end up with toxic metabolic byproducts which cause steve johnson syndrome or other stuff.
This can really make you become paranoid when you think about it.
I mean all the time I thought if I just use a medical interaction checker and it finds no interaction I'm safe but now I don't even trust these checkers anymore.
 
glab said:
hi, what got me worried in the first place is that i read in book about psychopharmacology which is only available in german that sertraline must not be mixed with lamotrigine because it interferes with the metabolization of
lamotrigine and this causes toxic byproducts. (i also made a thread about this on the forum).
But the thing is that not even Stephen Stahl mentions any of this in his books!
But it's mentioned on drugs.com, too. Why is such an important interaction not mentioned? Is it still relatively unknown? I don't know. But it's really unsettling cause if sertraline can do this
then who knows what other antidepressants or other drugs can do the same and then you end up with toxic metabolic byproducts which cause steve johnson syndrome or other stuff.
This can really make you become paranoid when you think about it.
I mean all the time I thought if I just use a medical interaction checker and it finds no interaction I'm safe but now I don't even trust these checkers anymore.
Click to expand...

The rash thing is really, really overblown.. it's really rare. Lamotrigine doesn't really have much in the way of interactions, except with stuff like Tegretol and Depakote. The monograph actually states that there's no interaction with sertraline.

I dunno about lamotrigine. It's really well tolerated by most people, it's got very few side effects and it's pretty safe, but I don't know what it does any more.. I somehow ended up on 600/day and I'm knocking that down.. I'm also not bipolar so I don't know why the fuck I've been on it for so long. I think if you are truly bipolar, it helps a lot to stabilize depressive episodes, so I've heard from bipolar friends. Beats lithium.
 
I have been on Lamotrigine for maybe 7 years now. The rash thing is overblown and was really only seen much when Lamotrigine first came on the market and much higher doses then are now used where used at the start of treatment. Also other anti-Convulsants such as Depakote (Divalproex aka just another Valproate) and Tegretol (Carbamazepine) are also known for causing Steven-Johnson syndrome. Either way i wouldn't worry about it and besides even if you do get it you have plenty of time to get to a doctor and stop it from getting worse.

I really don't get any major side effects or any real side effects at all from Lamotrigine and i am on 200mg's a day. I do get sun sensitivity though i do burn pretty easy anyway. I will burn now in about 20 minutes in the hot sun as opposed to abit over half a hour.
 
It didn't work for me and it made me really paranoid but I wish that it had. The people that it works for seem to all really respond to it well and are able to tolerate it for a long time. It's actually one of the better drugs I think. I've known a lot of people that liked it. It's definitely worth a shot. If you get the rash, just stop taking it.
 
If it works somehow, then how can I tell if it works? I often read that it's basically an add-on drug for depression and that it alone will not cure depression.
I have a really hard time to even tell if an antidepressant helps me or not cause I am not equally depressed all the time. I may have a few weeks where I feel so-so and then
when my problems become more acute I may feel absolutely terrible again in no time.
I needed something which either makes me feel better in general or which does at least prevent me from feeling terrible.

But since normal antidepressants don't really do much for me I have to try other stuff. I have tried pretty much everything except Effexor,Paxil,Prozac,TCAs and MAOI.
And I don't want to try Paxil and Prozac cause they have many drug interactions and they don't mix well with amphetamines and TCAs also do not really mix well with amphetamines.
I mean TCAs alone can already cause serious heart issues and when you add amphetamines to them then this could make it even more dangerous.
 
Have you considered tianeptine? Stay away from SNRIs, they are generally more effective than SSRIs but the withdrawal is a nightmare.
 
Yes I tried tianeptine at 37,5mg per day for 1 months. Did nothing for me. I also read that it's not indicated for ocd and I also have ocd.

I was on cymbalta. I went up to 120mg and it also did nothing then I got off it without major problems. But Effexor is said to be much harder to get off.

I was on Lexapro 20mg for 4 months and when I got off it I got brain zaps. I am currently on Vortioxetine and even now as I AM on it I still get brain zaps!
It's unbelievable. I mean how can you get brain zaps while being on a SSRI?

But I am sure when I get off Vortioxetine the brain zaps will return. But my doc said when I want to start with Lamotrigine I should better get off Vortioxetine
cause it's a new drug and maybe there are interactions which aren't known yet. When I am off Vortio I will probably get back on Lexapro even though Lexapro alone
didn't help me but I need to be on some kind of serotonergic drug. I simply assume this because of my ocd and also because amphetamines also lower serotonin.
 
I take Lamictal. It helps. It is quite transparent, i.e. I don't really feel "drugged" in any way shape or form but it helps with mood stabilization particularly as an add on to Wellbutrin, which is the primary antidepressant I take. SJS is a very rare risk, but a serious one, hence the amount of attention paid to it, but titrate slowly and watch for any skin manifestations and you'll be OK. If you are a Bluelighter you have almost certainly taken riskier risks.
 
I read that you can also get SJS after a few months. How likely is this? Does this mean you can be on a constant dose and think everything is fine and then suddenly you get SJS?
This is scary. I really don't want to have to worry all the time and check my body for rashes.

Do we at least know where the rash usually shows up and what it looks like?
 
I'm pretty sure it's something you will notice. I think you are supposed to look in your mouth though. Honestly, I wouldn't worry about it so much. You should look into tianeptine if you are that concerned about it. But it seems as if you are worrying about it for no reason. You just stop taking it and you will be fine, in the rare case that you actually get it.
 
The risk is extremely small, and concentrated at the beginning of therapy, and minimized by slow titration.

The rash is quite distinctive:
NSFW:

MtotTb-53OH3DvueOdUylA_m.jpg


although you should be on the lookout for, and immediately report to your doctor, any dermatological changes.
 
Okay thanks. But if you get a rash then do you have to take any emergency measures or do you simply stop taking the drug?

If I for example went to the ER at the weekened then there are usually young less experienced doctors. If I came to such a doctor with a rash
he would most likely simply tell me to stop taking it and keep an eye on the rash and come back if it gets worse.
 
I believe you just stop the drug, and that, is that!

Odds are, you would be going to hospital that is competent enough to be able to care for people on the weekend. The rash also appears to be pretty obvious. The doctor will almost surely be competent in spotting it out, and taking preventative measures so that your health improves speedily.

Keep us updated.
 
Ok thanks. I haven't yet started with Lamo cause I first have to stop with Vortioxetine and I slowly have to taper it off.
I will surely get withdrawal symptoms again. I will wait a few days and then I will reintroduce Lexapro cause going without any SSRI is not good.
Even though SSRIs don't really help much I think it's still necessary to take one especially when taking stimulants for adhd. I read that raising DA lowers SE.
 
If you haven't tried a TCA i would suggest giving them a go. I found Amitriptyline to work better then most anti-depressants until it stopped working. So there worth a try in my opinion. As for MAOI's i would try them but only after i had tried all the usual ones. Though with the Emsam patch (transdermal Selegiline) you don't have to go with the food restrictions because it bypasses the stomach which is where the inhibition of MAOI leads to the well known cheese reaction. You still have to watch what drugs you take though.
 
paranoid android said:
If you haven't tried a TCA i would suggest giving them a go. I found Amitriptyline to work better then most anti-depressants until it stopped working. So there worth a try in my opinion. As for MAOI's i would try them but only after i had tried all the usual ones. Though with the Emsam patch (transdermal Selegiline) you don't have to go with the food restrictions because it bypasses the stomach which is where the inhibition of MAOI leads to the well known cheese reaction. You still have to watch what drugs you take though.
Click to expand...

Hey PA, out of curiosity, what recreational drugs can't you take on it? It seems on just about every pill that I've picked up OTC it says you can't take it with an MAOI. Seems like a lot of interactions, is it not that big of a deal?
 
jammin83 said:
Hey PA, out of curiosity, what recreational drugs can't you take on it? It seems on just about every pill that I've picked up OTC it says you can't take it with an MAOI. Seems like a lot of interactions, is it not that big of a deal?
Click to expand...

Well any stimulants such as pseudoephedrine or Ephedrine, Pheylephrine or the cough suppressant and at higher doses dissociative Dextromethorphan are of course a no no due to their effect on various neurotransmitters. Any Amphetamines would be out as well and so would Cocaine or MDMA/MDA, etc. Anti-histamines are okayish but MAOI's increase the anti-cholinergic effect of such drugs i do believe. Some Opioids such as Demerol aka Meperidine aka Pethidine, Tramadol and Tapentadol would also be major no no's while taking Emsam. You still have to go by the drug interactions for old irreversible MAOI's with the Emsam patch but not so much the food interactions.
 
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