Bipolar Disorder Medication Side Effects: Lamictal (lamotrigine)

I’m reading over my older posts- so much of what I’ve written can still be used today- medications don’t change and our needs don’t change. I was on Lamictal for many years and it helped me get through a serious four year depression. My depression is better now and I am off the drug.  Medications can help us through tough depression times- and when we are better, we can lower doses or go off the medications.  Unfortunately, it’s not the same with mania. For many people, staying on mania drugs as a prevention tool is essential, but even then, doses can change and different medications can be found that have less side effects. No one and I mean no one really wants to take medications for bipolar disorder, but if you’re like me, medications are sometimes the only option.  Keep an open mind- keep using the management plan I write about in my books and always keep looking for new and better ways to manage this illness.  If medications are needed, I highly recommend Lamictal. It save my life and helped me move into a depression free world. You can get better! Here is the question!

 

Hi Julie,

I was taking generic Lamictal for 4 weeks during December, but around Christmas the side effects-headache, anxiety-became too much on 50mg.  I know you’re not a doctor, but in your experience do these subside over time. I’m a street musician in Portland and just getting turned on to your bi-polar crusade.  Your work looks pretty amazing.

Regards,

Ted

Hi Ted,

Well, side effects are so tricky as they depend on the person. For example, I take 500mg of generic Lamictal (also called generic Lamotrigine) and have more side effects when my dose gets too low!

The normal Lamictal dose is 250mg- but that is just an average. What matters is that it works- the dose depends on the person taking the meds.

My first question would be just that- did it work? If it did, you may want to wait out the side effects if you can- if they are even moderately tolerable. It’s such a great drug when it works, but the side effects can be tough. I had them for three months until they got better. Mine were severe neck stiffness and breathing problems. Now I get the restless legs and twitching! It is an anti epileptic drug, so it makes sense it would really affect our nervous systems. If the side effects really are impossible to live with, you have some options.

If you are well enough to function in terms of bipolar- then you can talk to your doctor about going onto a lower dose until you can tolerate the side effects and then very slowing going up in dose.  You have to be really careful about going down in dose though as withdrawal can be tough and painful!

This is definitely something to talk about with your doctor. I would have a list of questions to ask so that you can get the most out of an office visit. I don’t suggest doing this on your own as you need to be closely monitored for mood swings. I went down too quickly once and got super depressed.

It can take many months for a medication to work and many months for the side effects to lessen. Sometimes, they don’t go away and you have to switch meds. I hope your side effects can get better as Lamictal is such an amazing drug.

Good luck, maybe I will see you when I walk around in Portland!

Julie

7 comments to Bipolar Disorder Medication Side Effects: Lamictal (lamotrigine)

  • hopeful heart

    Hi Julie and Ted!

    I am just learning more about the use of several meds (esp. the anti-epileptic meds) and have been made aware of the fact that these meds can demand very lengthy introductions and very a gradual increases (or decreases, if/when decreases are “in order”) in hopes of evoking fewer side-effects.

    This time of adjusting can sometimes seem like a very long time and can become a bit disparaging.:(

    I was not able to tolerate lamotrigine, much to my dismay.:( I had started a “serious” rash (and more) even though we were increasing on a painfully slow dosing schedule.
    After assessing the rash, the dermatologists had verified lamotrigine was not an option for me.
    (I was very disappointed, as it seems to be a great option for many.)

    I have tried some other AEDs, in hopes of tolerating them. I have a limited tolerance. One of the other AED drugs had started a drug-induced autoimmune lupus for me. 🙁

    Is it likely that all of the anti-epileptic meds need comparatively slower titration (than with some of the other drug classes) in order to allow for better tolerance?

    Thanks for any input you share!:)

    Best wishes!:)

  • I was diagnosed with bi-polar 2 in 2004. In 2006 I started a gradual dosing schedule of Lamictal up to 100 mg that has worked fine. This website was very helpful.
    http://www.psycheducation.org/depression/meds/moodstabilizers.htm#specificGuidelines

    I experienced no side effects. However, in 2010 when the generic Lamotrigine became available my insurance would no longer pay for the brand name any longer. It took me two months before I figured out it was the new meds that were causing my rapid cycling. I did some research on-line and found out many others were experiencing the same things. Then further research enlightened me that the FDA allows 80% to 120% of the active ingredient for a generic. Now, when your illness requires maintains a balanced brain chemistry, this is a huge problem.

    I’m fortunate that I have the financial means to pay the additional $170 to switch back to the branded Lamictal. I

  • Sue

    I was recently diagnosed from anxiety disorder to bipolar in September. I started off with a 25mg dose of Lamictil and am now up to 100mg. Most of the time I think it works, but there are still times that I think I need something more. I have too many moments of anxiety and depression still, not so much of the mania anymore. What is your experience with this? Do I just need to focus on my symptoms or can another medication combined with the Lamictil help?

  • Nancy

    Julie, how do you deal with the threat of a medication’s side effects like the fear of Tardive Dyskenesia?

    • Hi Nancy, Here is a long answer to your question! I will put it in a blog post next week so that more people can learn from your question.

      **
      All meds have side effects. Some are more serious than others- and tardive dyskinesia is a serious one.
      Tardive dyskinesia is an unnatural movement of the mouth and jaw. It’s like a tic. The person can also run their tongue behind their lips in a circular motion. TD is a side effect of anti-psychotic medications.

      A brief history of anti psychotics.

      The first anti psychotics- also called neuroleptics- came on the market in the 40s. The first was Thorazine. The results from these meds were absolutely miraculous. For the first time in history, those with schizophrenia had some hope of a more stable life. This was especially wonderful for the parents. Of course, this was the beginning use of the drugs and no one had any idea what would happen in terms of side effects. As soon as hospitals realized how well these drugs worked, they started to move those with schizophrenia back into the community.

      It was a bit of a utopia for a while. A miracle. Then the problems started. The main one was that the medications were helpful for many schizophrenia symptoms, but many still remained and living in the community was not as easy has had been hoped. (This is another topic.) The next problem that started was the side effects. The main one was tiredness. We have this problem now with so many of our meds- so we can understand what it must have been like. You’re finally back in the community, but no one understands why you are so tired and can’t do anything! These drugs can make a person very fuzzy as well.

      What about Tardive Dyskenesia?

      The main physical concern regarding Thorazine and its companions such as Haldol and Trilafon was and still is Tardive Dyskenisia. All of these meds can cause odd movements in the body. Who knows why the TD is the most pronounced. The problem is that TD is not reversible. This was found out rather too late and many stayed on these drugs and had the permanent TD. That is why we are so incredibly careful now.

      It’s always a tradeoff. For some, a lifetime of institutionalization as compared to facial jaw movements and tics. And when you have schizophrenia, these decisions are not always easy. Well, they aren’t easy for any of us! But TD is not something many can live with.

      A Change: Second Generation Anti-Psychotics

      Drug companies knew that these ‘first generation’ anti psychotics could work miracles, but the side effects were finally seen as too risky. So new drugs were created with supposedly less side effects. These second generation anti psychotics including Zyprexa, Seroquel, Risperdal, Invega and Abilify were advertised as more successful drugs in that they were more effective and had less side effects.

      Here is what happened: There is no question there are less side effects than with the first generation drugs. The problem is that the side effects are still pretty intense for many people.

      Luckily, tardive dyskinesia is very rare in these new drugs. This was one of the goals of creating new drugs and it worked. I do know people who have had jaw movements from a newer drug- she went off it immediately. You can’t risk TD.

      You ask about specific drugs- only the older anti psychotics have a strong TD risk. It’s truly less in the newer ones. If you are looking on the internet for information on this topic, don’t forget that people tend to only write their bad experiences and it can be scary to read that someone who is on the same drug as yourself had trouble with TD.

      It’s important to remember that many, many people take anti psychotics with ZERO side effects. We just don’t talk about this very often.
      If you are worried about TD, talk with your prescriber and find out which anti-psychotic has the lowest risk and see if it will work for you.
      It can take a very long time to find the right meds. One good thing about anti psychotics is that you can go on and off them as needed. They don’t have to be long term. Your prescriber can help you with this. Make sure you work with someone who really understands your concerns.

      When you start any med, unless you are in an acute episode, you can microdose up to a dose that works. I always do this.
      Overall, unless you are taking the first generation anti psychotics, TD should not be a strong risk.
      Keep asking questions- it helps everyone!

      Julie

      PS: I always like to be clear about my views on medications. It’s a love/hate/respect/resentment/anger/relief/lifesaving/life wrecking/situation! Does that make sense? I would do anything not to have to take these meds- and I did everything I could for ten years to keep my management plan strong enough so that I didn’t need more meds. Then the illness caught up with me more and more and I needed help. I’m now on Lamictal, lithium, Zoloft, Ritalin and Ativan. I’m basically depression free for the first time in my life. The side effects have been terrible- from pass-out sleepiness to intestinal problems and weight gain, but they have gotten better and I’m finally more stable.

      But, if one of them had given signs of tardive dyskinesia, I would have stopped the medication. There are some side effects we can’t allow. Your question is a good one. Thanks Nancy!

  • Today, I went to the beach front with my kids. I found a sea
    shell and gave it to my 4 year old daughter and said
    “You can hear the ocean if you put this to your ear.” She placed the shell
    to her ear and screamed. There was a hermit crab inside and it pinched her ear.
    She never wants to go back! LoL I know this is totally off
    topic but I had to tell someone!

  • Sarah

    Hi Julie,

    Thanks for this great site! I’m on lamictal 75. 50 mg is not effective enough. At 100 my depression and anxiety gets worse. At 75 though I have had tics. Constant throat clearing, constant blinking and my tounge is pushing againt my teeth. I’ve also felt som numbness on me hands, feet and cheeks. I have been on this dosage for 14 days now. Is there any chance this side effect might go away as I adjust to the dosage?

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