Lamotrigine (Lamictal)

[DaveFoster]

I've been recommended by multiple doctors to try lamotrigine for anxiety.

It's used to minorly improve symptoms of depression and anxiety, but it's primarily used as a "mood stabalizer" similar to lithium. It's been linked to potential atrophic neurodegeneration over the long-term, and it can cause a lethal skin rash called Stevens-Johnson Syndrome (SJS).

It tends to have a favorable side effect profile apart from the aforementioned rash.

Does anyone have any experiences with lamotrigine?

Here's what I found on the RP forum as of 12/13/17:

"I have looked at this site for some time, searching for ways to lower my serotonin levels after having drug-induced Serotonin Syndrome and Bipolar II like symptoms, and consequently food tryptophan sensitivity that keeps returning me to serotonin toxicity.

This happened in September 2012, I got better with time, but then tried Lithium Orotate a year ago (which I then found 'enhances serotonin release') and prescribed Lamotrigine (part SSRI) just a few months ago, both were huge set-backs sending me nearly back to square one each time."

Source: After effects of "Serotonin Syndrome" - Advice please!

 

[InChristAlone]

If you don't have raised liver enzymes I'd stick with the cyproheptadine. This seems to have more side effects.

Do you have any ideas as to what is causing the anxiety?

Have you looked into anything outside of hypothyroidism? That is not the only cause of anxiety.

Along with cyproheptadine, and vit C I was also getting help by practicing DARE. I cannot recommend it enough for people with severe anxiety. Not saying it's just in your head, but you obviously have nervous system activation and a lot of the time it is because your amygdala was trained to see danger. Calming the amygdala, basically telling it you are safe then you can begin to come down from the constant fight or flight. Its not just blood sugar or hormones although obviously those can cause anxiety, but so can your brain, as in if it senses your worry as a perceived threat you will get fight or flight without any other thing going wrong in the body.

I got a little bit too involved in internet discussions today, was called a nutjob and that set my amygdala off and I got some panic symptoms. See I'm not cured, it's a brain issue. We can re train the brain though. Hard work. But it's worth it.

Good luck Dave.

 

[ecstatichamster]

A family member is on it. Nasty stuff. Vision disturbances. Very strange side effects. Kills libido. Testicle changes.

 

[DaveFoster]

If you don't have raised liver enzymes I'd stick with the cyproheptadine. This seems to have more side effects.

Do you have any ideas as to what is causing the anxiety?

Have you looked into anything outside of hypothyroidism? That is not the only cause of anxiety.

Along with cyproheptadine, and vit C I was also getting help by practicing DARE. I cannot recommend it enough for people with severe anxiety. Not saying it's just in your head, but you obviously have nervous system activation and a lot of the time it is because your amygdala was trained to see danger. Calming the amygdala, basically telling it you are safe then you can begin to come down from the constant fight or flight. Its not just blood sugar or hormones although obviously those can cause anxiety, but so can your brain, as in if it senses your worry as a perceived threat you will get fight or flight without any other thing going wrong in the body.

I got a little bit too involved in internet discussions today, was called a nutjob and that set my amygdala off and I got some panic symptoms. See I'm not cured, it's a brain issue. We can re train the brain though. Hard work. But it's worth it.

Good luck Dave.

I do have raised liver enzymes about double the range. My doc won't prescribe me cypro because she doesn't see the logical benefit despite my anecdotes that it improves all my symptoms. I'll continue to order it from All Day Chemist nonetheless.

Thanks, Janelle. You as well. Sorry to hear about the internet drama. I've heard good things about DARE, so I'll do some reading.

A family member is on it. Nasty stuff. Vision disturbances. Very strange side effects. Kills libido. Testicle changes.

Well that sounds miserable. The "atrophic neurodegeneration" certainly put me off. I'll have to do some more reading. Thanks for sharing.

 

[peatmás]

A relation was given Lamotrigine/Lamictal for epilepsy, after fairly good control with other agents. Lamotrigine seemed to promptly produce agitation, tremors, stiffness, nausea and impaired thinking. These side effects all disappeared when lamotrigine was stopped and re-appeared when lamotrigine was re-started. The family begged doctors to stop using the drug for this person. Other people I knew given lamotrigine for seizure control felt blunted and confused.

 

[DaveFoster]

A relation was given Lamotrigine/Lamictal for epilepsy, after fairly good control with other agents. Lamotrigine seemed to promptly produce agitation, tremors, stiffness, nausea and impaired thinking. These side effects all disappeared when lamotrigine was stopped and re-appeared when lamotrigine was re-started. The family begged doctors to stop using the drug for this person. Other people I knew given lamotrigine for seizure control felt blunted and confused.

Very interesting, thank you.

 

[goodandevil]

Yeah it's no good. Gave me severe skin problems. I think you need some anxiety, we have a complete spectrum of feeling that shouldnt be supressed.

 

[Dhair]

Stevens-Johnson Syndrome isn't just a rash; it is a potentially life threatening disease. I agree with the others. Not worth the risk.​

 

[Frankdee20]

It’s amazing that at the end of the day, people forget that medications like these are chemicals. It’s always better to not introduce them into the system.

 

[DavidGardner]

I take 50 mg every night for bipolar. I'm also on Seroquel (quetiapine). It has reduced my anxiety, and I have no side effects (knock on wood). I tried increasing the dose to 100 mg twice but was never able to stick it out more than a few days. I felt worse, but it was hard to tell whether it was the medication or just the persisting agitation from bipolar.

That aside, if you are not diagnosed with bipolar disorder, I wouldn't really recommend it. It basically lowers glutamate, which is one of the things that causes agitation during a hypomanic, manic, or mixed state. (It is not an SSRI though, has no influence on serotonin.) If you don't have bipolar disorder, I can't see how it would do you any good.

Is your doctor aware that Cyproheptadine is a potent 5-ht2 antagonist? Surely, if they're a psychiatrist they would understand that 5-ht2 agonism can potentiate anxiety, hence an antagonist at that receptor site would be anxyolitic. That is partly why anti-psychotics can also reduce anxiety.

So no I don't recommend Lamictal in your case, but just to be clear, the drug does have its benefits for bipolar sufferers. And that risk of SJS is less than one in a thousand, and almost always happens at higher doses or from increasing the dose too quickly.

 

[ecstatichamster]

Eye side effects are very common. And testicle effects.


The effect of Vigabatrin, Lamotrigine and Gabapentin
on the fertility, weights, sex hormones and biochemical
profiles of male rats
A. S. Daoud*, H. Bataineh**, S. Otoom*** & E. Abdul-Zahra*
Departments of Neuroscience*, Physiology** and Pharmacology***,
College of Medicine, Jordan University of Science and Technology, Irbid, JORDAN
Correspondence to: Azhar Daoud, MD,
Professor of Child Neurology, College of Medicine
Jordan University of Science and Technology
King Abdullah University Hospital
P O Box 3030, Irbid 22110, JORDAN
TEL: +962 79 5600420 FAX: +962 2 7278119
EMAIL: [email protected]
Submitted: December 11, 2003 Accepted: December 20, 2003
Key words: Lamotrigine; Gabapentin; Vigabatrin; fertility; weight; sex
hormones; biochemical profile; male rats
Neuroendocrinol Lett 2004; 25(3):178–183 NEL250304A01 Copyright © Neuroendocrinology Letters www.nel.edu
Abstract PURPOSE: A case control study was conducted to assess the effect of Sabril (Viga-
batrin), Lamictal (Lamotrigine) and Neurontin (Gabapentin) on fertility in male
rats. Their effect on the body and organs weight and certain biochemical profiles
including total serum protein, cholesterol, triglycerides, serum glutamic oxalo-
acetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT),
serum testosterone, and FSH levels were also measured.
METHODS: several parameters, concerning fertility were measured in 40 albino
male rats of Sprague Dawley strain, they were divided into 4 groups, group one
received vehicle (distilled water), group two received Vigabatrin in a dose of 200
mg/kg body weight, group three received Lamotrigine in a dose of 30 mg/kg body
weight, and group four received Gabapentin 100mg/kg body weight. All the male
rats in these groups received the different medications for a complete reproduc-
tive cycle (60 days). After 24 hours of the last dose, the animals were weighed
and autopsied under light ether anesthesia. Parameter of fertility that has been
measured in this study includes: sperm count and motility, weight of different
reproductive organs, germ cell and interstitial cell population, serum testoster-
one and FSH levels and assessment of pregnancies in females mixed with tested
males. Biochemical profiles such as serum cholesterol, serum triglycerides,
serum bilirubin, SGOT, SGPT level are all measured. The results of the histo-
logical, histometerical studies and biochemical profiles were compared to that of
the control group, and the significance of these results was measured using stu-
dent’s “t” test.
RESULTS: There was significant reduction in the body weight and the weight of
the testes, epididymis, seminal vesicles, ventral prostate, and vas deferens in the
antiepileptic fed male rats in comparison to the control group (p>0.001). There
was significant reduction in testicular cells population dynamics including both
germinal cell types and interstitial cell types in the antiepileptic fed male rats in
comparison to the control group. There was also significant reduction in histo-
metrical parameters and sperm dynamics in the antiepileptic fed male rats his-
tologies in comparison to the control group. There was significant reduction in both testos-
terone and FSH levels (p<0.001) in the antiepileptics fed male rats in comparison to the
control group. There was also significant reduction in pregnancy rate observed in female
rats exposed to the tested male rats among antiepileptic fed male rats compared to con-
trols. The results of biochemical profiles assessment showed significant reduction in serum
glucose, serum cholesterol, serum triglycerides levels and significant increase in serum bil-
irubin, SGOT, and SGPT levels in antiepileptics fed male rats in comparison to the control
group.
CONCLUSIONS:
Fertility rate and other parameters concerned with fertility, sex hormones and certain bio-
chemical profiles were significantly disturbed in male rats fed with three of the second-gen-
eration antiepileptic drugs Vigabatrin, Lamotrigine, and Gabapentin, indicating a possible
toxic effect of these three medications on sexual organs, liver, and lipid metabolism.

 

[DaveFoster]

I take 50 mg every night for bipolar. I'm also on Seroquel (quetiapine). It has reduced my anxiety, and I have no side effects (knock on wood). I tried increasing the dose to 100 mg twice but was never able to stick it out more than a few days. I felt worse, but it was hard to tell whether it was the medication or just the persisting agitation from bipolar.

That aside, if you are not diagnosed with bipolar disorder, I wouldn't really recommend it. It basically lowers glutamate, which is one of the things that causes agitation during a hypomanic, manic, or mixed state. (It is not an SSRI though, has no influence on serotonin.) If you don't have bipolar disorder, I can't see how it would do you any good.

Is your doctor aware that Cyproheptadine is a potent 5-ht2 antagonist? Surely, if they're a psychiatrist they would understand that 5-ht2 agonism can potentiate anxiety, hence an antagonist at that receptor site would be anxyolitic. That is partly why anti-psychotics can also reduce anxiety.

So no I don't recommend Lamictal in your case, but just to be clear, the drug does have its benefits for bipolar sufferers. And that risk of SJS is less than one in a thousand, and almost always happens at higher doses or from increasing the dose too quickly.

I've heard it 0.006% chance of getting it, and of that, only 5% are fatal, so the chance for SJS remains ridiculously low, and again, with proper dose titration the chance drops further, and in a younger person (and also usually men) immunological reactions become less dangerous.

I've suspected that I've been bipolar for my whole life. I've had some people mention it, and one girl I spent some time with in high school told me outright. I've had the whole spectrum of mental illness for the entirety of my life, so I wouldn't be surprised at all.

My pdoc said my doc was employing CYA ("cover your ****") due to the potential liver problems, but he expressed some interest in cypro. He asked if it's like hydroxyzine (also an antihistamine), and I made a good case for it. He leaned toward gabapentin rather than lamotrigine, and there's also lithium. Honestly I'd like to have something on hand as an option, but necessarily only begin a regular regimen if symptoms become too severe. I've also considered using emodin, but I'm not sure of the interactions, and I don't like adding drugs with no clinical evidence of their safety in combination. Honestly, this whole approach may only be short-term, as I plan to taper off these drugs once I increase my thyroid dosage, or at least reduce them.

Have you considered trying 75 mg instead of going to 100 mg immediately? Also, do you know if shifting moods dramatically six times throughout the day resembles BPD, or what were your symptoms?

Eye side effects are very common. And testicle effects.


The effect of Vigabatrin, Lamotrigine and Gabapentin
on the fertility, weights, sex hormones and biochemical
profiles of male rats
A. S. Daoud*, H. Bataineh**, S. Otoom*** & E. Abdul-Zahra*
Departments of Neuroscience*, Physiology** and Pharmacology***,
College of Medicine, Jordan University of Science and Technology, Irbid, JORDAN
Correspondence to: Azhar Daoud, MD,
Professor of Child Neurology, College of Medicine
Jordan University of Science and Technology
King Abdullah University Hospital
P O Box 3030, Irbid 22110, JORDAN
TEL: +962 79 5600420 FAX: +962 2 7278119
EMAIL: [email protected]
Submitted: December 11, 2003 Accepted: December 20, 2003
Key words: Lamotrigine; Gabapentin; Vigabatrin; fertility; weight; sex
hormones; biochemical profile; male rats
Neuroendocrinol Lett 2004; 25(3):178–183 NEL250304A01 Copyright © Neuroendocrinology Letters www.nel.edu
Abstract PURPOSE: A case control study was conducted to assess the effect of Sabril (Viga-
batrin), Lamictal (Lamotrigine) and Neurontin (Gabapentin) on fertility in male
rats. Their effect on the body and organs weight and certain biochemical profiles
including total serum protein, cholesterol, triglycerides, serum glutamic oxalo-
acetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT),
serum testosterone, and FSH levels were also measured.
METHODS: several parameters, concerning fertility were measured in 40 albino
male rats of Sprague Dawley strain, they were divided into 4 groups, group one
received vehicle (distilled water), group two received Vigabatrin in a dose of 200
mg/kg body weight, group three received Lamotrigine in a dose of 30 mg/kg body
weight, and group four received Gabapentin 100mg/kg body weight. All the male
rats in these groups received the different medications for a complete reproduc-
tive cycle (60 days). After 24 hours of the last dose, the animals were weighed
and autopsied under light ether anesthesia. Parameter of fertility that has been
measured in this study includes: sperm count and motility, weight of different
reproductive organs, germ cell and interstitial cell population, serum testoster-
one and FSH levels and assessment of pregnancies in females mixed with tested
males. Biochemical profiles such as serum cholesterol, serum triglycerides,
serum bilirubin, SGOT, SGPT level are all measured. The results of the histo-
logical, histometerical studies and biochemical profiles were compared to that of
the control group, and the significance of these results was measured using stu-
dent’s “t” test.
RESULTS: There was significant reduction in the body weight and the weight of
the testes, epididymis, seminal vesicles, ventral prostate, and vas deferens in the
antiepileptic fed male rats in comparison to the control group (p>0.001). There
was significant reduction in testicular cells population dynamics including both
germinal cell types and interstitial cell types in the antiepileptic fed male rats in
comparison to the control group. There was also significant reduction in histo-
metrical parameters and sperm dynamics in the antiepileptic fed male rats his-
tologies in comparison to the control group. There was significant reduction in both testos-
terone and FSH levels (p<0.001) in the antiepileptics fed male rats in comparison to the
control group. There was also significant reduction in pregnancy rate observed in female
rats exposed to the tested male rats among antiepileptic fed male rats compared to con-
trols. The results of biochemical profiles assessment showed significant reduction in serum
glucose, serum cholesterol, serum triglycerides levels and significant increase in serum bil-
irubin, SGOT, and SGPT levels in antiepileptics fed male rats in comparison to the control
group.
CONCLUSIONS:
Fertility rate and other parameters concerned with fertility, sex hormones and certain bio-
chemical profiles were significantly disturbed in male rats fed with three of the second-gen-
eration antiepileptic drugs Vigabatrin, Lamotrigine, and Gabapentin, indicating a possible
toxic effect of these three medications on sexual organs, liver, and lipid metabolism.

Thanks, hamster. Maybe small amounts of lithium with pregnenolone would be better then. Of course, progesterone can also cause the testicles to shrink, and with sedatives like gabapentin one may drink more coffee, so the caffeine might compensate with an androgenic effect.

It’s amazing that at the end of the day, people forget that medications like these are chemicals. It’s always better to not introduce them into the system.

Indeed. I'm resistant to try meds, but sometimes it's necessary to get through a certain period of stress.

Yeah it's no good. Gave me severe skin problems. I think you need some anxiety, we have a complete spectrum of feeling that shouldnt be supressed.

I agree, but I'd rather be able to experience emotions rather than be debilitated by them.

 

[ReSTART]

Are you going to try a GABA analogue?

 

[DaveFoster]

Are you going to try a GABA analogue?

That would be gabapentin (Neurontin). I don't really want to, although I have it prescribed. I'd rather use progesterone, and honestly rather lamotrigine than gabapentin.

It's quite telling when I can get a script for an anticonvulsant despite never exhibiting any signs of epilepsy, although when I reiterate the benefits of a particular drug on all of my symptoms (cyproheptadine), I'm dismissed because of the "lack of conclusive evidence" regarding its benefit.

 

[DavidGardner]

My pdoc said my doc was employing CYA ("cover your ****") due to the potential liver problems, but he expressed some interest in cypro. He asked if it's like hydroxyzine (also an antihistamine), and I made a good case for it. He leaned toward gabapentin rather than lamotrigine, and there's also lithium. Honestly I'd like to have something on hand as an option, but necessarily only begin a regular regimen if symptoms become too severe.

Have you ever tried clonazepam? If you've used progesterone, the effect is similar; they both affect the benzodiazepine receptor. Of course with clonazepam you wouldn't have the same hormonal interactions; also it is far superior in my opinion for treating anxiety. I rarely use it, but I have it in case of a panic attack or severe tremors. The issue with it, of course is not side effects (which are usually minimal to nonexistent) but the risk of addiction. Having been addicted to alcohol, I am of course very cognizant of this potential, but I don't know of anything else that is as effective for stopping a heart-pounding panic attack or the violent tremors that sometimes make it impossible for me to work.

Have you considered trying 75 mg instead of going to 100 mg immediately? Also, do you know if shifting moods dramatically six times throughout the day resembles BPD, or what were your symptoms?

I considered it, but the normal titration is directly from 50 to 100 mg, which is what my doctor prescribed. Honestly, both are fairly low doses, and I was so desirous to get relief that I just went along with her prescription. The quetiapine was added after I told her I didn't want to continue with the higher dose of lamotrigine. And I'm happy I went that route. Low-dose quetiapine in mainly anti-histamine and anti-adrenergic, moderate doses are anti-serotonergic, and anti-dopaminergic properties don't kick in until higher doses. So I'm fine with it for now.

And yeah, mood shifts that occur within a 24 hour period can be a symptom of bipolar disorder; it's called ultradian cycling. And it sucks. I've had it many times. I've had cycles that shifted moment-to-moment--like I'm smiling one instant and frowning the next and back again.

Indeed. I'm resistant to try meds, but sometimes it's necessary to get through a certain period of stress.

Yes, and this point really seems to get lost on people sometimes. I've tried hundred of dollars worth of supplements, and not one of them actually treats bipolar disorder the way medications do. Say what you like about chemicals or the pharmaceutical companies, those drugs are researched and proven to do what they are meant to. And they're often damn good for it. I have many times had the experience of suffering horribly from psychiatric disorders, only to find extraordinary relief from a medication. When you've had that experience it makes it harder to be dogmatic.

 

[DaveFoster]

Have you ever tried clonazepam? If you've used progesterone, the effect is similar; they both affect the benzodiazepine receptor. Of course with clonazepam you wouldn't have the same hormonal interactions; also it is far superior in my opinion for treating anxiety. I rarely use it, but I have it in case of a panic attack or severe tremors. The issue with it, of course is not side effects (which are usually minimal to nonexistent) but the risk of addiction. Having been addicted to alcohol, I am of course very cognizant of this potential, but I don't know of anything else that is as effective for stopping a heart-pounding panic attack or the violent tremors that sometimes make it impossible for me to work.



I considered it, but the normal titration is directly from 50 to 100 mg, which is what my doctor prescribed. Honestly, both are fairly low doses, and I was so desirous to get relief that I just went along with her prescription. The quetiapine was added after I told her I didn't want to continue with the higher dose of lamotrigine. And I'm happy I went that route. Low-dose quetiapine in mainly anti-histamine and anti-adrenergic, moderate doses are anti-serotonergic, and anti-dopaminergic properties don't kick in until higher doses. So I'm fine with it for now.

And yeah, mood shifts that occur within a 24 hour period can be a symptom of bipolar disorder; it's called ultradian cycling. And it sucks. I've had it many times. I've had cycles that shifted moment-to-moment--like I'm smiling one instant and frowning the next and back again.



Yes, and this point really seems to get lost on people sometimes. I've tried hundred of dollars worth of supplements, and not one of them actually treats bipolar disorder the way medications do. Say what you like about chemicals or the pharmaceutical companies, those drugs are researched and proven to do what they are meant to. And they're often damn good for it. I have many times had the experience of suffering horribly from psychiatric disorders, only to find extraordinary relief from a medication. When you've had that experience it makes it harder to be dogmatic.

I agree, meds work, although I have some measure of relief from other modalities, but thyroid really has a league of its own compared to the other hormones (although maybe DHT and testosterone could be as effective.)

I've stayed away from quetiapine because of the weight gain, but I have a friend who takes it. It helps sleep noticeably.

I've taken clonazepam (Klonopin), and it's amazing. I've never felt so free in my own skin, but it's a drug of abuse for that reason. It's a good state to strive for, though, and I hope to feel like that all the time with the proper modalities.

 

[CoconutEffect]

Some clear thinking psychiatrists regard it as the gold standard for Bipolar ll

I hated it, the titration period was awful, strange somatic symptoms. I also seem to have an across the board refractoriness to anti-convulsants... except for Phenyotin in 2012, my one and only erstwhile true love. :/

 

[DaveFoster]

Some clear thinking psychiatrists regard it as the gold standard for Bipolar ll

I hated it, the titration period was awful, strange somatic symptoms. I also seem to have an across the board refractoriness to anti-convulsants... except for Phenyotin in 2012, my one and only erstwhile true love. :/

Also known to rarely cause SJS. I've considered phenytoin (Dilantin), as it's useful in small doses for autism.

The treatment of autism with low-dose phenytoin: a case report

Conclusion
This case report provides the first potential evidence that a low dose of phenytoin, a widely used and well tolerated anti-epileptic medication, may be capable of modifying the core social cognitive deficits associated with autism spectrum disorders. While acknowledging this is a single case study, the lack of availability of safe and effective treatments to address the important core deficits associated with autism spectrum disorders makes this case noteworthy.

 

[satsumass]

Really lots of fear mongering here. Your doctors have experience using lamictal on doZens of patients each. I used it off and on for years—should have never stopped it. Been on 200mg for past few months with absolutely zero side effects, significant benefits. No antidepressants for the first time in my life. Combining it with 300mg lithium and first time in ears I’m not depressed in winter time. Titrate slow but don’t be scared of transient issues. BP2 also.

This should be first line treatment—forget trying to self titrate any of the other stuff mentioned here.

 

[ecstatichamster]

Boards are full of people who have suffered terrible effects. Just google. Very harmful stuff.