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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Joe Bloe on February 21, 2007, at 16:16:15
My pdoc wanted me to add 25 mgs of Lamictal to my daily Prozac 20 mgs and Adderall XR 20 mgs. After much reluctance, I finally agreed.
Since starting lamictal 5 days ago, I feel my depression has improved significantly, but I began to experience many problems with concentration, memory recall, and even speaking. My career is dependent on strong memory recall and speaking in front of others in pressure situations. I've already been embarrassed in front of colleagues because of a zombie-like feeling.
I spoke with my pdoc and he said that what I was feeling was most likely NOT from the Lamictal because it doesn't work so quickly, and that what I was feeling could really be from anything, but was probably from my anxiety/obsessive thoughts about meds. He said to stop the Lamictal for the time being.
I'm sure he thought that even if my side effects were all in my mind, they are still "side effects" that are having a negative impact on my life.
But any thoughts on whether these quick effects/side effects are possible or is it all in my mind or due to some other factor, as my pdoc suggested?
Posted by psychobot5000 on February 21, 2007, at 17:02:24
In reply to Lamictal effects by day 5? PDoc says 'no', posted by Joe Bloe on February 21, 2007, at 16:16:15
"Since starting lamictal 5 days ago, I feel my depression has improved significantly, but I began to experience many problems with concentration, memory recall, and even speaking"
___Hi,
I went on Lamictal a little less than a year ago, and I'm afraid I had much the same experience. Rapid improvement in depression (which was not sustained for more than a few days--this also seems to be a pattern according to the reseach I've read), but then a gradual onset of cognitive symptoms. Was a gradual onset, but by around eight days in my mind was slowing down a lot--a very strange feeling. Took several weeks to go away, by the way (though I was on it for longer than you've been), but they most certainly did go away.
The particularly frustrating and confusing part of it was that these side-effects were not listed in any recongnizable form on the official materials, and like yours, my doc thought it unlikely that Lamictal was causing it (though he didn't rule it out). Luckily, I found several posts on this board, and other places, where patients had a similar experience.
Lamictal does seem to be clean of cognitive side-effects for a lot of people. Cleaner than other drugs of its class, apparently. But (as far as I can tell) there are a significant minority of people who experience these problems with memory recall, mental focus, and etc. It's real. I attest to that from my own experience.
Incidentally, it seems that there are six large studies on Lamictal's mood benefits that recently turned up (they were apparently suppressed) that show no evidence of antidepressant efficacy for Lamictal, aside from the initial acute mood-benefit. It seems that it's not working out very well as an antidepressant.
Best of luck,
'Psychbot'
Posted by chiron on February 21, 2007, at 17:07:33
In reply to Lamictal effects by day 5? PDoc says 'no', posted by Joe Bloe on February 21, 2007, at 16:16:15
Although the literature based on the sample size may say it requires a certain amount of weeks, the participants in the larger-scale real world and the psychiatrists who have seen enough patients in the real world, know that each individual is different and changes may occur sooner than 4-6 weeks.
This is not to say that the initial reaction is permanant or that your body will not adapt. The side effects you were experiencing look similar to the ones that are common with Topamax, which seem to go away with most people. I actually could not remember my address one time during my Topamax trial (yes, embarrasing). But it did seem to get better. Unfortunately, it didn't give me the mood lift.
I feel like I am pretty good at being objective & observant with my physiology, and Lamictal definitely increased my irritability within a couple of days. I think your pdoc sounds limited in his awareness.
Posted by Joe Bloe on February 21, 2007, at 18:15:51
In reply to Re: Lamictal effects by day 5? PDoc says 'no', posted by chiron on February 21, 2007, at 17:07:33
I do like the benefits so far. I feel less depression, anxiety, obsessive thoughts, and more motivation to do work, (so, more motivation but less ability, weird I know). These could be attributable to the quick mood enhancing abilities that have been mentioned. I also think the pdoc thinks I am bipolar II and has designs of me being on it at higher doses.Today I am trying a 12.5 mg dose to see how that works. I've read that some people do start on this dose.
Posted by TheMeanReds on February 22, 2007, at 10:42:35
In reply to Lamictal effects by day 5? PDoc says 'no', posted by Joe Bloe on February 21, 2007, at 16:16:15
> My pdoc wanted me to add 25 mgs of Lamictal to my daily Prozac 20 mgs and Adderall XR 20 mgs. After much reluctance, I finally agreed.
>
> Since starting lamictal 5 days ago, I feel my depression has improved significantly, but I began to experience many problems with concentration, memory recall, and even speaking. My career is dependent on strong memory recall and speaking in front of others in pressure situations. I've already been embarrassed in front of colleagues because of a zombie-like feeling.
>
> I spoke with my pdoc and he said that what I was feeling was most likely NOT from the Lamictal because it doesn't work so quickly, and that what I was feeling could really be from anything, but was probably from my anxiety/obsessive thoughts about meds. He said to stop the Lamictal for the time being.
>
> I'm sure he thought that even if my side effects were all in my mind, they are still "side effects" that are having a negative impact on my life.
>
> But any thoughts on whether these quick effects/side effects are possible or is it all in my mind or due to some other factor, as my pdoc suggested?You said the lam gave you unwanted side effects, and your doc said no. Then doc said its paranoia in your head, but took you off of the lam?
Lamictal is an odd drug. I noticed a lift in mood at 25mg, my starting dose. I'm on 200mg now. I notice zombie effects, and high anxiety effets as well. It's weird. If I HAVE to do something that requires concentration and low anxiety, I drop a klonopin and skip the lam. I'm not suggesting you do this, but its the only way for me to function in those situations. I'm currently trying to figure out a better(safer) way to go about things.
Posted by circusboy on February 22, 2007, at 15:38:23
In reply to Lamictal effects by day 5? PDoc says 'no', posted by Joe Bloe on February 21, 2007, at 16:16:15
Funny... I felt the same things, and when I told my pdoc she had a similar reaction. Her exact words were "you're not feeling anything from this drug." Hm.
By the end of the second week at 25mg the side-effects seemed to diminish. Interestingly, I felt them less at 50mg. Fortunately I've also got a script for Ritalin, 5mg of which mitigates the cognitive side-effects somewhat. Still, I'd been concerned enough about the cognitive stuff that during today's appointment the doc decided we should "take a break" from the Lamictal...
I don't know. It certainly has improved my mood... Interestingly, for the first time in my life with a psychiatric drug, the people around me noticed it before I did.
I should be more specific about the side-effects:
- Diminished sleep quality. I've been waking up way earlier than I want to, and haven't been able to fall back asleep. I also haven't been remembering my dreams and wake up without eye crusties (waking up with crusty eyes is a sign that I've slept well.)
- Slowed thinking. Small memory/word recall impairment. More trouble making connections.
- Blurry vision. Also (though this has almost gone away) slower urine stream. Feels like desipramine in this way! (There is a paper on PubMed about lamotrigine binding to nicotonic receptors).
- Connected to both above: impaired driving ability.
- More easily overwhelmed (though this is also going away).In spite of all this, I don't hate the drug. These effects are relatively mild, and seem to be diminishing. It's worth repeating that people around me have liked me better on it.
What next? Back to the Alternative board..? ..sigh..
-cb
Posted by Joe Bloe on February 22, 2007, at 17:06:08
In reply to Re: Lamictal effects by day 5? PDoc says 'no' » Joe Bloe, posted by circusboy on February 22, 2007, at 15:38:23
> By the end of the second week at 25mg the side-effects seemed to diminish.I'm on day 2 of 12.5 mgs. I feel much less difficulty concentrating than at 25 mgs. I am still feeling much better: less depression, anxiety, etc., so I want to give it a chance. Hopefully I will feel them diminish at 12.5 and I can go up from there in dose as necessary.
> I should be more specific about the side-effects:
> - Diminished sleep quality. I've been waking up way earlier than I want to, and haven't been able to fall back asleep.This seemed like a problem at 25 mgs, but I slept well last night.
> - Slowed thinking. Small memory/word recall impairment. More trouble making connections.
Yes. Hopefully this passes as well. I am going to try some choline with it.
> - Blurry vision. Also (though this has almost gone away) slower urine stream. Feels like desipramine in this way! (There is a paper on PubMed about lamotrigine binding to nicotonic receptors).
When you say "binding to nicotonic receptors," does this mean that Lam has an effect similar to nicotine (does nicotine also effect the sodium channels?), or is it the opposite? I had a cigarette on the Lam and I felt like I had smoked 3 at once, which makes me think it is the former.
Thanks
Posted by psychobot5000 on February 22, 2007, at 17:15:39
In reply to Re: Lamictal effects by day 5? PDoc says 'no', posted by Joe Bloe on February 22, 2007, at 17:06:08
> I'm on day 2 of 12.5 mgs. I feel much less difficulty concentrating than at 25 mgs. I am still feeling much better: less depression, anxiety, etc., so I want to give it a chance. Hopefully I will feel them diminish at 12.5 and I can go up from there in dose as necessary.
>I'd be interested to hear if, in a few weeks, you maintain your positive response on the 12.5 (or whatever dose you're then on). It'd be nice to know that some low dose could be useful.
P-bot
Posted by circusboy on February 22, 2007, at 22:30:23
In reply to Re: Lamictal effects by day 5? PDoc says 'no', posted by Joe Bloe on February 22, 2007, at 17:06:08
> When you say "binding to nicotonic receptors," does this mean that Lam has an effect similar to nicotine (does nicotine also effect the sodium channels?), or is it the opposite? I had a cigarette on the Lam and I felt like I had smoked 3 at once, which makes me think it is the former.
>I'm thinking it's anticholinergic (or antinicotinic, anyway), from the last line of the abstract... and from comparing my experience with Lamictal to my experiences with desipramine and nortriptyline.
I don't know enough neuroscience to understand exactly what's going on here... Anyone else? Anyway, here's the abstract:
* * *
Neuroreport. 2007 Jan 8;18(1):45-50.Lamotrigine is an open-channel blocker of the nicotinic acetylcholine receptor.
Valles AS, Garbus I, Barrantes FJ.UNESCO Chair of Biophysics and Molecular Neurobiology and Instituto de Investigaciones Bioquimicas de Bahia Blanca, Bahia Blanca, Buenos Aires, Argentina.
Lamotrigine is an antiepileptic drug employed in the treatment of partial epilepsies. We studied its possible interaction with channels other than its known therapeutic target, the voltage-gated sodium channel, using the adult muscle nicotinic acetylcholine receptor as a model system. At the single-channel level, lamotrigine caused a dose-dependent (a) diminution in mean open time, (b) increase in mean burst duration and (c) increase in the area of a new closed-time component. A simple linear channel blocking mechanism accounts for these results. Thus, lamotrigine exerts a blocking action on the muscle nicotinic acetylcholine receptor.
PMID: 17259859 [PubMed - in process]
Posted by psychobot5000 on February 22, 2007, at 22:49:58
In reply to Re: Lamictal and nicotinic acetylcholine receptors, posted by circusboy on February 22, 2007, at 22:30:23
>>...using the adult muscle nicotinic acetylcholine receptor as a model system. At the single-channel level, lamotrigine caused a dose-dependent (a) diminution in mean open time, (b) increase in mean burst duration and (c) increase in the area of a new closed-time component. A simple linear channel blocking mechanism accounts for these results. Thus, lamotrigine exerts a blocking action on the muscle nicotinic acetylcholine receptor.
>
> PMID: 17259859I think that it's saying that lamotrigine causes a change in firing rates in these nicotinic pathways, and that these are consistent with 'a simple linear channel blocking mechanism,' by which I think they mean the sodium channel blocking. I believe anti-epileptics that effect sodium channels and glutamate change the firing rate and amplitude of nerve signals all over the body--sodium channels are pervasive. So if I read this right (I may not be), I think it's not being seen particularly as anticholinergic or antinicotinic--that's just the area they're checking in this study, and it's 'consistent' with lamotrigine's (and other AEDs') effect on sodium or maybe calcium channels.
Someone else may have a better understanding of this.
Posted by Joe Bloe on February 23, 2007, at 0:27:37
In reply to Re: Lamictal and nicotinic acetylcholine receptors » circusboy, posted by psychobot5000 on February 22, 2007, at 22:49:58
This discussion is very interesting.
I'm definitely not a neuroscience expert either, (as perhaps the following post may show), but I have an interest in learning, which is why I suppose most of us are here.
I looked up "anticholinergic" on wikipedia [http://en.wikipedia.org/wiki/Anticholinergic], and the effects of Anticholinergics seem to match the side effect profile of Lamictal rather closely - that is, the side effects actual people are talking about.
I was reading the post just below on "Brain Steroids" [http://www.dr-bob.org/babble/20070219/msgs/734959.html]
The poster takes several acetylcholine boosting drugs and supplements. Now, if Lamictal is anticholinergic, (and if the primary therapeutic action of Lamictal is its anticholinergic effect, then does taking cholinergic drugs and supplements potentially mitigate any benefit from Lamictal?
Or does Lamictal have other therapeutic properties that makes it worthwhile to take the drug while trying to limit it anticholinergic properties?
Posted by psychobot5000 on February 23, 2007, at 0:43:42
In reply to Re: Does Lamictal plus cholinergic make sense?, posted by Joe Bloe on February 23, 2007, at 0:27:37
I agree that this is interesting...especially as it -conceivably- makes it possible to avoid Lamictal's side-effects.
>Now, if Lamictal is anticholinergic, (and if the primary therapeutic action of Lamictal is its anticholinergic effect, then does taking cholinergic drugs and supplements potentially mitigate any benefit from Lamictal?
>Well, maybe. But it seems to me possible (assuming Lamictal is actually anticholinergic, of course) that Lamictal might have antinicotinic/anticholinergic side-effects (the cognitive ones), while its theraputic effect is caused by something else. While Lamictal is definitely not well understood (and may not have long term mood-benefits, lets not forget), researchers seem to believe its effects on the GABA and glutamate systems are likely responsible for its mood effect.
> Or does Lamictal have other therapeutic properties that makes it worthwhile to take the drug while trying to limit it anticholinergic properties?
Maybe so? It seems to me a perfectly good idea to at least -try- aricept (or another cholinesterase inhibitor) as an antidote to the thinking issues--It would certainly help us learn something, I think, if that worked. For me, psychostimulants were unhelpful, but maybe (?) something increasing Acetylcholine would act more directly?I would like to remind anyone reading this that some people seem to believe cholinesterase inhibitors can lower one's mood or cause depression. I don't know how real the possibility is.
Best,
Psychbot
Posted by circusboy on February 23, 2007, at 8:08:38
In reply to Re: Does Lamictal plus cholinergic make sense?, posted by Joe Bloe on February 23, 2007, at 0:27:37
It's important to note that -- in spite of our experience with nicotine -- the worst anticholinergics in terms of cognitive effects seem to preferentially block *muscarinic* acetylcholine receptors. Also, that many people can adjust to mild (e.g. desipramine) to moderate (nortriptyline) anticholinergics without too many ill effects. SLS, for instance, takes (took?) a bunch of nortriptyline and he's still pretty damn sharp. :)
From my experience so far with Lamictal, it feels more like a mild anticholinergic, like desipramine. And desipramine is a drug I might have stayed on (if it hadn't interrupted my sleep so terribly by putting my heart into overdrive at night).
[I also have a pet wild hypothesis that desipramine likes the nicotinic receptors better, since I had very mild cognitive effects on it and serious urinary retention/constipation issues, while I had practically no physical effects from nortriptyline but MAJOR cognitive ones].
-cb
Posted by randermin on February 24, 2007, at 21:22:25
In reply to Re: Does Lamictal plus cholinergic make sense? » Joe Bloe, posted by circusboy on February 23, 2007, at 8:08:38
Is this common? I haven't taken this yet, but will be in a couple weeks.
any zombie effect is a complete mandate against a drug for me,
I hate the idea of losing emotional functions in any form on a very deep level.
is it like the seroquel zombie effect? thanks, o
Posted by psychobot5000 on February 25, 2007, at 0:38:01
In reply to zombie effect?, posted by randermin on February 24, 2007, at 21:22:25
> Is this common? I haven't taken this yet, but will be in a couple weeks.
> any zombie effect is a complete mandate against a drug for me,
> I hate the idea of losing emotional functions in any form on a very deep level.
> is it like the seroquel zombie effect? thanks, oSo I think you're asking whether a 'zombie effect' is common on Lamictal? Hmm. I suppose I did find that it lowered my range of emotions a bit--didn't make me feel dead, but decreased highs and lows after being on it a few weeks. ...And it can have these cognitive slowing side-effects we've been talking about, though it doesn't seem to happen to most people. But I don't know if any of that is exactly a zombie effect... Most takers say it's low on cognitive side-effects compared to other anti-epileptic drugs.
Posted by randermin on February 25, 2007, at 12:34:15
In reply to Re: zombie effect? » randermin, posted by psychobot5000 on February 25, 2007, at 0:38:01
> > Is this common? I haven't taken this yet, but will be in a couple weeks.
> > any zombie effect is a complete mandate against a drug for me,
> > I hate the idea of losing emotional functions in any form on a very deep level.
> > is it like the seroquel zombie effect? thanks, o
>
> So I think you're asking whether a 'zombie effect' is common on Lamictal? Hmm. I suppose I did find that it lowered my range of emotions a bit--didn't make me feel dead, but decreased highs and lows after being on it a few weeks. ...And it can have these cognitive slowing side-effects we've been talking about, though it doesn't seem to happen to most people. But I don't know if any of that is exactly a zombie effect... Most takers say it's low on cognitive side-effects compared to other anti-epileptic drugs.sounds no different than effexor
Posted by Nolegirl323 on February 26, 2007, at 21:03:11
In reply to Re: zombie effect? » randermin, posted by psychobot5000 on February 25, 2007, at 0:38:01
> > Is this common? I haven't taken this yet, but will be in a couple weeks.
> > any zombie effect is a complete mandate against a drug for me,
> > I hate the idea of losing emotional functions in any form on a very deep level.
> > is it like the seroquel zombie effect? thanks, o
>
> So I think you're asking whether a 'zombie effect' is common on Lamictal? Hmm. I suppose I did find that it lowered my range of emotions a bit--didn't make me feel dead, but decreased highs and lows after being on it a few weeks. ...And it can have these cognitive slowing side-effects we've been talking about, though it doesn't seem to happen to most people. But I don't know if any of that is exactly a zombie effect... Most takers say it's low on cognitive side-effects compared to other anti-epileptic drugs.My zombie experience is different. I wouldn't really call this a zombie effect, more like a 'mellow as jello' feeling..
I also noticed very vivid dreams, very haunting dreams which would cause great depression/anxiety when I woke up.
So, I started taking Lamictal in the a.m.
That has been problematic as I have little motivation to work when I go to work due to the 'mellow as jello' effect.I also find that I have more saliva than I used to. It's not so bad that I am drooling, but I am definitely producing more saliva than before.
Memory loss, especially short term; but I also take 4mgs of xanax per day. Xanax is known to have amnestic effects.
Posted by Joe Bloe on March 1, 2007, at 0:53:13
In reply to Re: zombie effect?, posted by Nolegirl323 on February 26, 2007, at 21:03:11
I take my small (starting) dose of lamictal (12.5 mgs) at night because it makes me so foggy and incapable of doing much. It also helps me sleep.
I've added a choline supplement to it and it's really helping with cognitive side effects. I want to wait a few more days before I post something more complete on my experience with choline and lamictal. But so far so good, and best of all, depression, phobias, etc. still in remission after 2 weeks.
This is the end of the thread.
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