Phase 2

its been almost 3 years off the C and i am now ready to wean off the only other 'scrip i still take: lamotrigine. i'd wanted to quit it on my one year anniversary off the C, but withdrawal kicked my butt so much i just wasn't ready - now i am. i've held down a great job for just over a year and life is much more stable. 

I started taking anti depressants in 1996 - zoloft, then wellbutrin then effexor, soon after that the doc added depakote and then in 2004 we switched to cymbalta and lamotrigine. after years of therapy i realized i never should have been on any of this stuff in the first place - it made things much worse. i did a rapid taper off the C and ended up in what was effectively cold turkey withdrawal. 

i'm able to draw on the lessons learned from the pages of this site and the support of truly caring and knowledgeable people on the forum - all of you! as a result, yesterday i dropped from 200 mg to 175 mg of lamotrigine - effectively a 12.5% drop. this time around its with the blessings of my GP, i fired my p-doc after the C fiasco. my current doctor is letting me drive and supports me 100% - if i need to slow down, and as i progress no doubt i will, he's cool with that. i am looking at a 3 1/2 to 4 month taper. i don't know how things will work out, lamotrigine has a bad rep too, but not as bad as the C.

Hi Brz!!
 
You are off to a good start on the lamotrigine. Have you done any research on how to handle it, what supplements help, etc.

If there is anything I can do for you let me know.

thanks dr hat! i've done a lot of research and found some good stuff on the surviving anti-depressants forum based on a 10% titration. 

http://survivinganti...al-lamotrigine/

http://survivinganti...ts-or-capsules/

i also found some interesting stuff in general:

http://survivinganti...rawal-syndrome/

http://survivinganti...s-make-you-sad/

this includes a discussion of using lamictal/lamotrigine for mitigating anti-d withdrawal symptoms:

http://survivinganti...rawal-symptoms/

as for supplements, i already take per day: 4050 mg of  omega 3 fish oil with 2850 mg of active omega 3 puritan's pride. 5000 IU of D-3 (by dr. 's orders) now brand. now brand probiotic-10 25 billion 10 probiotic strain caps - two per day of those. they include two highly recommended probiotic bacteria for anxiety, lactobacillus rhamnosus and bifidobacterium longum (don't trust the spelling!) not sure, but i think those two pro-b's help the production of GABA in the gut. i also take daily for arthritis  1500 mg of tumeric curcumin standardized to 95% curcuminoids with black pepper extract from piper nigrum (recommended for absorption)

of course, your insights are always welcome!

It looks to me like you are off to a great start. Keep us posted.

God Bless

its been a week. so far okay. a 12.5% reduction in lamotrigine and i've been a little tired, some anxious edginess but mostly okay. i am getting a little dizzy off and on as well. at work i have a standing desk and usually stand 4-6 hours every day. this week i can only handle about 2 hours. i have a really nice "high" herman miller chair at work so i am finally getting some use out of it.

one more week on 175 mg of the "L" and i will step down to 150 i suspect that drop will be a little tougher and i think i will take it much more slowly, after that, we'll see. 

its been two weeks and a day since i started my wean off of 200 mg lamotrigine. yesterday i stepped down from 175 mg to 150 mg. i was real stable for that last week. just like when i stepped down the first 25 mg, i am really tired and stressy stuff at work feels more stressy than normal. i just have to keep telling myself - its not that big of a deal. today i got "short" with my "jr" manager (her boss is our real manager, she's an assistant of sorts). she is a poor choice for managing people - no skills in that dept at all. she is good at managing data. putting her into an operational role of my dept was an after thought. it was out of character for me to question a decision of hers but she has been pushing everyone's buttons as of late, for no reason. she approached my desk to follow up on an email she had sent me moments earlier and it was very obvious she was trying to create a problem that doesn't exist. however, that is no excuse for my behavior. its not like i got called out for being insubordinate but i do feel bad that i challenged her when others were within ear shot. i know i wouldn't have done it before yesterday - i would have sucked it up like i always do. i'm glad its the weekend. i think i need it for this recent reduction to settle. i do have a big family shindig on sunday - easter. i'm putting together a quinoa tabouli with cilantro and poblano peppers - i'm making it up as i go but i think it will work really well. i need the escape ;-)

overall, it seems fatigue to be the biggest side effect, followed by some dizziness/lightheadedness and irritability. other than the episode with the manager which created a short "spike" this afternoon, i've had no anxiety above and beyond the residual that developed during C withdrawal - very mild.

i realize i am still at a relative high dose level where its often much easier to handle a drop. on the C i went from 90 to 60 in one step and felt side effects no more than i am now. same when i went from 60 to 30 a year later. it wasn't until i went from 30 to 15 that the bottom started dropping out for me. then i did the every other day thing over a couple weeks and jumped off - when hell boke loose. what will be interesting is how the drop from 75 down to 0 will go. i'm thinking at that point i'll be trying to add 5mg pills into the mix to help slow things down. i have no problems stretching this out as long as i have to.

its been a week and 2 days since i dropped down to 150 mg. i still feel a little "fragile" emotionally. my next planned  drop is thursday but not sure i will. i might hold a little while longer. if i do drop it will be by 15 mg - 10%, down to 135 mg. i need to get with my doc to call in a scrip of the 5 mg tablets.

things are a little more stressy these days. we just got tenants of nine years out of a rental property we plan to sell. a lot more work to get it ready than we thought. i am working 7 days a week - at the office 5 days and weekends are all at the house. hubby has more time to devote during the week (musicians aren't 9-5!) usually i'd have the energy but i can't keep dropping my lamotrigine dose and keep up the pace on the weekends.

since i am doing a slow taper on the L - unlike i did with cymbalta, i am starting to understand the compulsion to "rip the bandaid off". while i don't feel anywhere near as bad as i did when i went CT, there's always an edge hanging over me. its hard to imagine stringing this feeling along for 3-4-5 months. however, i know the alternative is even worse - something i didn't know the first time around. so for those of you doing it right the first time by bead counting... no matter how tempting the idea, do not think you can just "get it over with" you are at great risk of creating what would end up being a longer and more disabling recovery process overall.

on a side note - i just learned that lamotrigine has a half life of 29 hours. i had always thought it was 13. when i've missed an entire dose it sure feels awful, pretty much the same as it did missing a dose of the C (half life of 12 hrs). i guess "half life" doesn't tell the whole story.

Thanks for the update Brz, reviens nous pour la suite!

gail, je suis revenu!

"no matter how tempting the idea, do not think you can just "get it over with" you are at great risk of creating what would end up being a longer and more disabling recovery process overall."

Oh what a pearl of wisdom. How true.
 

having a difficult time coming up with a realistic dosage drop/schedule. thought i had it figure out and now none of it makes any sense to me. going to the docs at 9 tomorrow. we'll see...

Hi there,

i am now at 125 mg. had to hold for a week until i could see the doc. got a big supply of 25 mg to mix/match with some 100 mg tabs - with cutting in half and such i've got something to work with now for a gentler taper. 

biggest issue is being very tired.  headaches also. i am irritable for the first week or so but nothing big deal. a little "sorrow" here and there

jus' checking in...

been at 125mg lamotrigine for a week now other than the day i dropped from 150-125 (last saturday) i've felt tired - but good! what's amazing is how i've handled everything in spite of one of the stressy"ist"weeks at work ever! i come hoe in teh evening totally exhausted - but my performance has met/exceeded expectations. i thought about dropped 12.5 mg - 10%  today but decided to hold off one more week since the last drop was over 15%. i will drop to to 112.5 mg next saturday and may consider shortening each next drop to 7-10 days

Doing great Brz.

You know what you are doing and I don't worry about you. You will succeed. Just a matter of time.

i stepped down to 112.5 mg lamotrigine on saturday. glad i didn't do a fraction more. i'm okay but its amazing how such a little drop (10%) can have such an impact. again its fatigue, dizziness and the physical symptoms of anxiety. my head's on straight. i'm thinking clearly, but i get palpitations and short shallow breaths. so i have to focus on breathing - a lot. in spite of it all i managed to spend a good six hours in the hot sun yesterday ripping out weeds/plants/vines in front of a rental house we're selling. drank about a 1/2 gallon of water. i took on a bougainvillea, holly tree and spanish bayonet at the same time. ow! i slept really really well last night. 

today i felt the heart palpitations creep up all day while i was at work. it was like thunder in my chest by the time i left this evening. again, nothing mental, all physical. but its still anxiety-just without the fear. while my doc is great and is letting me do this at my own pace, even he had no idea i would need to take things this slow. i told him since i already went through it with the "C" - i know better. 

its manageable - but ONLY because i'm taking it slow. same rules apply with the C folks. take it slow, no matter how tempted you may be to speed things up. playing the next drop by ear, but i am thinking i'll step down to 100 mg in the next 10-14 days. 

fishing hat - thanks for the reminder about the magnesium. i forgot all about that. i keep forgetting to run by by local natural foods store to find some. 

on saturday i stepped down my lamotrigine to 106.25 mg (from 112.5 mg). i held at 112.5 mg for three weeks rather than my standard 2 weeks. it was hard to stabilize the drop from 125 to 112.5 so i spent an extra week and then dropped by less than 10%. i want to drop the remaining 6.25 to get to an even 100 mg by the week's end if i can handle it. other than needing to take a short nap on Saturday afternoon i didn't feel any effects. if i am able to do that it will mean its taken 3 months to cut my dosage by 50% total and from what i understand that's the easiest part of the drop.  

i can't stress enough how taking it slow makes a huge difference. i am amazed at how subtle drops can have such an impact. all throughout the major side effects of the withdrawal are 1) fatigue 2) dizziness 3) low-grade anxiety 4) irritability. the fatigue and dizziness wear off after a few days but the anxiety waxes and wanes throughout. its manageable but i have to be very self-aware that i don't over react to what in reality are small issues. i am vulnerable to catastrophic thinking so focused, slow, diaphragmatic breaths and taking time out to think things through are essential for me to maintain good relationships and keep my head on straight. no need to disturb myself over self imposed drama.

i am thinking this is going to take  at least another 4 to maybe 6 months to get through. i have to remind myself there is no hurry. 

A man of wisdom. Keep us the good work and keep us posted. I am going to add your withdrawal regimen to my lamotrigine file when you are done.

make that a woman of wisdom;-)

was planning to drop down to a straight 100 mg of lamotrigine today - but maybe tomorrow? or a week from today? <sigh> only because anxiety got real bad yesterday - the worst in years, actually. all physical. weak/achy muscles, major heart palpitations, shakiness, disoriented, unable to focus. i think it was exacerbated by the chelated magnesium glycinate i took. Solgar brand. I started thursday evening as per directed, 400 mg/day - 200 mg in the morning and 200 at night, did that for 24 hours and nearly went over the edge yesterday. unfortunately i was at a company "event", a special treat they took us bowling. anxiety does absolutely nothing for my game ;-). got better last night as i avoided my evening dose. got a great night's sleep, felt way better this morning and then within in hour it all came back. i didn't take any this morning. i did some research and saw several references to the 1% who don't tolerate it well and the anxiety increases. what i was interested in was the why. in some folks they already get enough, too much magnesium is known to create a "paradox effect" in anyone. also, even though the label doesn't say so, starting low and working up is recommended. makes TOTAL sense. with others, the type of magnesium is also important. some folks don't tolerate the chelated glycinate well. others don't do well with the magnesium citrate - such as in Calms. not having a good balance between magnesium, calcium and D-3 can also have an effect on some. more research to do for sure.

i also take 5000 iu's of D-3 as per Dr's orders - have been since the fall. i don't take any extra calcium but drink a lot of almond milk and eat a lot of yogurt and leafy greens.

i am also posting this to the "Nutritional Support" forum as i'd like to hear input from others who may have something to share.

Magnesium and calcium are both regulated by what is called magnesium channels and calcium channels in the cell membranes. Therefore the form of the magnesium is important. Amino acid chelated magnesium is the one with the least risk of this complication. This phenomena is most frequently developed in those who have taken magnesium too long and have developed low calcium as a result or have been taking Vitamin D3 for a period of time and the D3 levels are elevated. It is recommended that anyone taking a magnesium supplement should have their magnesium and calcium levels checked every 6 months and if taking vitamin D3 then that level should also be checked every 6 months. High vitamin D3 is at almost epidemic proportions in the US due to it becoming a popular supplement. I have not only read the research literature on this but have also been told this by endocrinologist as well as the various primary care drs I have had over the years. I use to take magnesium supplements. By the way, if serum magnesium levels are high it can take a few months for them to come down. When mine finally reached the high limit it took nearly 6 months foe it to return to normal. You really need to get some blood work done to see where you are dealing with.

Sorry about the gender mistake. You are obviously a wise and smart woman.

getting blood work up is a good idea but insurance only covers it once a year during my physical since its a "screening"- any other time it is a "diagnostic" and is applied to my deductible.

perhaps if we're only looking at levels of certain vitamins and minerals it won't be a bank breaker like the full-on CBC/lipid profile/et would be if paid out of pocket. i got my last in october 2016. i just looked my results up from last fall (all my labs are uploaded and available on-line) at that time my d3 was 20 ng/mL which is right at the lowest of the low-normal range and falls into the category of "insufficient". 19 is officially "deficient". its been 8 months of 5000 iu's of d-3, i would hope my levels are up but doubtful they've reached the 100 mL level that raises alarms. 

i recently learned that the zinc/copper ratio is critical to neurotransmitter health. excessive copper and a deficiency in zinc can lead to anxiety. not sure the most accurate method for testing on that. 

It is a blood serum test that takes about two days to get back.

been awhile since an official update.  here's to a 50% drop since march 31 and I'm still in one piece!

i dropped to 100 mg of lamotrigine june 24. its been two weeks and i'm not going to attempt another drop for at least a week. stress at work (major push to increase sales to encourage investors) and stress with personal investments. nothing bad , per se, just lots going on. one house for sale, pending contract fell through back on the market and so it goes. another we've been upgrading before putting back on rental market - tenants have now agreed to contract and move in tomorrow. lots to juggle.

the withdrawal's impact on me of course impacts my relationship wth my husband, but we're doing okay. after the cymbalta withdrawal he now understands and his expectations have adjusted dramatically. we'd both just like to be able to take a break and toss the canoes on the racks and head out for a paddle. but not this week <sigh>

its mostly all about the irritability, anxiety and catastrophizing. i've noted mood swings - given lamotrigine is a mood stabilizer that's not a surprise. today i felt a level of depression i've not felt in years - it helps to accept it as nothing more than a withdrawal symptom and not as any part of a "new normal". i'm okay now. each moment has its own rewards and its own challenges.

on a positive note - we're headed back up to our house in northwest north carolina for the solar eclipse! plans are to be within the "path of totality" http://www.eclipse20...in_the_path.htm on august 21!

I was real lucky yesterday and got to spend the entire day with the wife including some fishing. A real nice break from things. You and your husband need some quality time as you can. Even if it just some 'cuddle' time on the couch for 30 minutes or so when you are having a 'good spell'.

its been four months and a week since starting the drop from 200 and i've been holding at 100 for almost 1 1/2 months. i haven't had a day where i felt stable enough to step down again. if i do it will only be by about 5 mgs. if i cant get the smaller tabs i'll have to quarter my 25 mgs for a 6.5 dose. however its hard to cut evenly. even a slight variance can create additional symptoms. i may have to try water titration. i know many folks haven't had issues with a lamotrigine taper of only a couple months - but this is hard for me. i think going CT from cymbalta left me very sensitive to med changes. another reason not to be tempted to rip the band aid off when withdrawing. 

not sure the source of stress that is complicating my withdrawal - lots of little things but nothing major. we are planning a canoe trip on the silver river tomorrow - up to silver springs. lots of wild/feral monkeys there. left over from an old attraction from the 1930's. they were abandoned and have thrived in the woods along the silver and ocklawaha rivers. i love that paddle.

You know Brz, lamotrigine comes in doses as small as 2 mg. These are chewables for children. You might talk to your dr about getting some of those. Also. Lamotrigine is very slightly soluble in water (0.17 mg/mL at 25°C) and slightly soluble in 0.1 M HCl (4.1 mg/mL at 25°C). It can be titrated using water but it will have a lot of fine suspended particles in solution so must be shaken well be fore use. I notice that some people dissolve it in regular milk (not fat free) because it is more soluble in the fats in milk.
 
I think you are right about the difficulty being still sensitive from your Cymbalta withdrawal. Normally the drs recommend. if possible. to wait two years before discontinuing another antidepressant because the serotonin synapses have not fully recovered. While lamotrigine is not an ssri or snri it does have some affinity for the 5htp synapses (serotonin uses the 5htp synapses), This may be adding to the problems.

Keep us posted. I would like to see how this goes for you.

Oh yea, you could also weight your pills and then use a razor blade to shave off some. You will need a good set of balances.

thanks for the tip on the milk vs water. i have read about shaking it up really well first - makes total sense. we have a digital jeweler's scale. not sure if that is sensitive enough. i have no idea how accurate it is.

its been three years since i took my last does of "C" - however, i think the sensitivity is here to stay. i noticed right after quitting the C i had extreme sensitivity to all drugs/supplements/etc couldn't tolerate any alcohol - its what made me quit smoking weed - which would create severe anxiety. i had paradoxical reactions to certain drugs - like ambien (i would only take occasionally). i became allergic to fluoroquinolone antibiotics - like cipro - of which i've taken many times before. those are bad guys anyway (but that's another issue). i can barely tolerate caffeine anymore. it all started within a month of the CT from the C. however the paradoxical reactions no longer occur.

i forgot about the 2mg. from what i understand the doc has to request them straight from glaxosmithkline. not available generic at that dose. i think they're free, but not sure if there's a limit. 

i'll get through this. we're in the process of selling one of our rental properties - it can be nerve wracking but nothing i'm not familiar with. i'll be glad when we get rid of this one. hopefully that will help. closing's at the end of this month