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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 mjbogdanov on July 8, 2008, at 6:44:51
I have been on Lamictal for several weeks at 50 mgs.
I have tried to go up but get agitated and cannot sleep. The problem I am having though is that my heartbeat feels labored, especially when I am lying down or when I get up from a reclining position. At that point my heart just pounds, not particularly fast but hard. It seems to be pounding harder than normal, again not particularly quickly. I have had a hard time to describe it to my pdoc but he is certain that it isn't Lamictal because it's not a typical side effect. They think I should 'work it out' in therapy citing some well reasoned notion that my body has learned to react to meds and I have to 'unlearn' it (sounds a little nuts to me but I'm trying to be open-minded and not over-react.) I have been very med-sensitive in the past and there is arguement as to whether I am bipolar. I am terrified and am not sure what to do. I have had some reasonably good response to the Lamictal but now the anxiety is creeping in and I am concerned about heartbeat stuff. Any thoughts?? They did send me for an EKG but that is a 30 second reading and can't tell one much. Does anyone think this is a metabolism issue?
Posted by SLS on July 8, 2008, at 7:47:20
In reply to Lamictal - Strange heartbeat/Anxiety, posted by mjbogdanov on July 8, 2008, at 6:44:51
> I have been on Lamictal for several weeks at 50 mgs.
> I have tried to go up but get agitated and cannot sleep. The problem I am having though is that my heartbeat feels labored, especially when I am lying down or when I get up from a reclining position. At that point my heart just pounds, not particularly fast but hard. It seems to be pounding harder than normal, again not particularly quickly. I have had a hard time to describe it to my pdoc but he is certain that it isn't Lamictal because it's not a typical side effect. They think I should 'work it out' in therapy citing some well reasoned notion that my body has learned to react to meds and I have to 'unlearn' it (sounds a little nuts to me but I'm trying to be open-minded and not over-react.) I have been very med-sensitive in the past and there is arguement as to whether I am bipolar. I am terrified and am not sure what to do. I have had some reasonably good response to the Lamictal but now the anxiety is creeping in and I am concerned about heartbeat stuff. Any thoughts?? They did send me for an EKG but that is a 30 second reading and can't tell one much. Does anyone think this is a metabolism issue?No. You might be experiencing dysautonomia. This is a condition of an imbalance between the sympathetic and parasympathetic systems of the autonomic nervous system. In the case of depression, there is too much sympathetic (fight or flight) and too little parasympathetic (feeding, sex, calmness). It is possible that you are experiencing what I believe is an exaggeration of the depressive dysautonomia that might occur as one is beginning to improve. It is a sort of window that one passes through on the way to remission. I would continue to go up to 200mg as quickly as your doctor will allow you to.
1. Difficulty urinating
2. Dry mouth
3. Clenching teeth
4. Heart palpitations
5. Accelerated heart rate
6. Tremulous hands (shaking)
7. Constipation
8. Heart burn
9. AnxietyWhich of these are you currently experiencing?
If you are experiencing most of these, I would give these symptoms time to pass as your system begins to reregulate itself as the result of passing through this window of dysautonomia. It is a positive antidepressant response that exaggerates the state of depressive vegetative symptoms. You might be on your way to remission. 200mg is the "sweet spot".
Does any of this make sense to you?
- Scott
Posted by SLS on July 8, 2008, at 7:49:31
In reply to Lamictal - Strange heartbeat/Anxiety, posted by mjbogdanov on July 8, 2008, at 6:44:51
By the way...
If you should respond in the way I described, please post your observations.
Thanks.
- Scott
Posted by SLS on July 8, 2008, at 9:59:02
In reply to Re: Lamictal - Strange heartbeat/Anxiety » mjbogdanov, posted by SLS on July 8, 2008, at 7:47:20
I forgot to ask...
What other drugs are you taking?
- Scott
Posted by Phillipa on July 8, 2008, at 12:07:37
In reply to Re: Lamictal - Strange heartbeat/Anxiety, posted by SLS on July 8, 2008, at 9:59:02
I think if it were me since I did take 50 mg of lamictal and it didn't cause any of these symtoms just excessive salivation which caused every 5 second spitting had to stop. Slept fine with my usual 15-20mg of valium. I would do a 24 holter monitor just to be safe. And if I may ask what is your age and do you have any health conditions that might contribute to that feeling? Must be scarey. Phillipa
Posted by mjbogdanov on July 21, 2008, at 7:24:46
In reply to Re: Lamictal - Strange heartbeat/Anxiety » mjbogdanov, posted by SLS on July 8, 2008, at 7:47:20
Hi Scott;
Thanks for the reply. Wish I'd looked for it sooner as the last couple of weeks have been pretty bad. Got too scared and went down on the dose and am trying to go back up. Not fun. The syndrome of symptoms you describe is very familiar. My hands aren't shaking yet but everything else is happening. Interestingly, the symptoms feel worse when I get up from a seated position or roll over in bed. Scares the heck out of me. There is also a sensation of pressure over the sternum.
To fill in the blanks, I am not taking anything else at present. I was taking Prosom (estazolam) but they want me to try Rozerem instead. Haven't done that yet but will need to try because my sleep is very fractured.
Not sure where things are now with increasing dose. Last appointment wasn't a good one, mainly arguing with the doc about trust issues. I've only been seeing him for a few months. He said that if I don't trust him, I should see someone else. I said if I was to try to develop trust, he shouldn't say things like that to me. Difficult.
Will keep you posted though. Yours was the only response (including pdoc, cardiac doc, resident) that even sounded like it makes sense. Don't think I would even be considering going back up without the info as stated. Thanks much.
Posted by mjbogdanov on July 21, 2008, at 7:40:27
In reply to Re: Lamictal - Strange heartbeat/Anxiety » mjbogdanov, posted by SLS on July 8, 2008, at 7:47:20
Scott -
Also may be of interest that I suffer from chronic fatigue as well.madeleine
Posted by Treehugger on July 24, 2008, at 12:17:21
In reply to Re: Lamictal - Strange heartbeat/Anxiety » SLS, posted by mjbogdanov on July 21, 2008, at 7:40:27
Hi - I started Lamictal 7 days ago, 12.5 mg per day (drug sensitive so going slow) I felt an initial postive response for a couple of days except for sleeping less & feeling a little agitation. Last night I had - I'll call it a panic attack, & took .5 Xanax which worked. It is fairly common for me to have periods of arrythmia, but it has gotten worse, & my hands were actually (left hand) trembling, fingers jerking, last night. Feeling agitated & a little manic a lot of the time, & butterflies (big ones) high in my stomach. I do not have a diagnosis of bipolar, just SAD & depression. My rapid cyling led me to want to try Lamictal thinking I might be bipolar 2 - I also take 1mg. Clonazepam & .25mg atenolol a day. So - I am concerned about upping dose which I was going to start tomorrow - 50mg, fearing the side effects will get worse. I would like to hang in there, but not sure I can. No sign of rash. I guess I am looking for some encouragement to continue, or advice if it sounds like this is not a good med for me. TH
Posted by blueboy on July 28, 2008, at 9:46:11
In reply to Re: Lamictal - Strange heartbeat/Anxiety » SLS, posted by mjbogdanov on July 21, 2008, at 7:24:46
SLEEP: I'm extremely susceptible to various types of insomnia. My experience so far is that my sleep has become better on Lamictal. Well, MUCH better, although how much of that I can attribute to the Lamictal, I am not certain.
Rozarem gave me exactly zero help. I might as well have been taking a placebo, even at 8 times the recommended dosage. But I would be loathe to take a benzo every day, as I have problems with addiction anyway.
There are a lot of excellent fairly new drugs, such as Ambien, Sonata and Lunesta, that provide good drowsiness with minimal side effect and no proven habituation or addiction. (Not extremely new -- Ambien has in fact gone off patent in the US and is available as a generic.)
SIDE EFFECTS:
I have learned to be very careful attributing even marked changes as side effects of a drug unless they are downright bizarre. When I started taking Lamictal, I got a rash that I had never had before, and it scared the hell out of me due to the potential for severe or even fatal Stevens-Johnson rash.
I went to a dermatologist on an emergency appointment and she told me that the rash positively was not caused by a drug. I've had the same type of thing happen several times.
The reason I say all this, is that I have experienced racing heartbeat and arrhythmia when I go to bed on occasion, unrelated to a drug (afaik). One thing that definitely causes it in my own case is excessive sugar or refined carbohydrates. I also seem to experience it as an "anxiety attack" when I have been through a bit of stress.
It's a horrible sensation, but not physically harmful, in my case, although I would be loathe to tell someone that any heart symptoms were not serious. I actually had more extensive tests, including a stress test and an echocardiogram.
Someone posted that this is not a listed side effect for Lamictal; on the other hand, it doesn't sound totally off the wall to me.
One note: The most attractive thing about Lamictal to me is its low incidence of side effects. It is probably the only thing I have ever taken that has any beneficial effect, and almost zero side effects.
The other choices for mood stabilizers have a reputation for noticeable to severe side effects.
> Not sure where things are now with increasing dose. Last appointment wasn't a good one, mainly arguing with the doc about trust issues. I've only been seeing him for a few months. He said that if I don't trust him, I should see someone else.
He sounds like a jerk. A lot of pdoc's (and physicians in general) have their own issues, and it sounds to me like he is immature and has issues with his own self-confidence.
One would expect a doctor to take the patient's complaints seriously, even if he didn't think the drug was causing them. If he is that threatened by such complaints, I would find another doctor ASAP. I consider his attitude *extremely* unprofessional and unsatisfactory.
The same thing happened to my (90-year-old) mother recently, only it was an internist who grabbed a package of Elevil and told her to take it (not for depression -- I think it was for fibromyalgia). When she told him she had taken it before and it caused too many side effects, he got furious, actually yelled at the old girl about "trust" and stomped out of the room!
So I'll tell you what I told her. Don't go back to the guy, period. Any doctor whose ego is threatened by a patient complaining of side effects -- well, let's just say, I'd run the other way.
Posted by Treehugger on July 28, 2008, at 21:49:29
In reply to Re: Lamictal - Strange heartbeat/Anxiety, posted by blueboy on July 28, 2008, at 9:46:11
BB - I realize that you were not responding to my post, but I found it very helpful - thank you - I am continueing the Lamictal - a couple more days & I will raise to 25mg, which is the normal starting dose. For me slower is better. I am wondering why you believe your arrythmias are caused by sugar or carbs - at times I have thought that a large plate of pasta, or a late night bowl of popcorn could have caused mine. It is difficult to know why - I am 64 with a family history of heart problems, so I suppose it could be that. Also I am easily addicted to things, one being coffee - another possibility. Thanx again, TH
Posted by bimini on July 29, 2008, at 10:54:39
In reply to Re: Lamictal - Strange heartbeat/Anxiety, posted by Treehugger on July 24, 2008, at 12:17:21
Ditto blueboy about your doc. I think your response to this doc was what he needed to hear!
I am taking Lamictal 150mg for several years for complex partial seizures, have dysautonomia and mital valve prolapse. Getting up and starting to walk and balance has been a problem since TBI post car accident. I also feel an electric sensation from sternum down to sole of feet. Not pressure, more like a flow of bouncing particles. None of this got worse with Lamictal. I was also prescribed Atenolol, but that interfered with dysautonomia and I needed to stop.
I increased the dose much, much slower. 12.5 at a time alternating days, then 12.5 for a week, then additional 12.5 alternating ... Any faster and my lymph nodes swelled. I gave it several months to decide if Lamictal was helpful for me. It didn't stop seizures entirely but they happen less often.
Side effects were headache, tinitus and magnified peripheral vision. All but the vision weirdness went away. I don't pay attention to what side effects AREN'T listed. If a symptom starts with a med, then it should be reported to the company and precriber.
My mitral valve is mildly erratic, increase when dehydrated. Seizures may also be related to arrythmia, valve flutter, autonomic problem. Scoliosis, psoriasis, flat feet, slim bodytype ... may offer a propensity to all of this. Or the other way around. My brain is starting to shut off -
My arrythmia, postural blood pressure adjustment lag, cognitive functions ... get better with a glass of water.
Water, what a magic potion.That's my story, hope it is helpful.
bimini
Posted by Treehugger on July 29, 2008, at 11:55:25
In reply to Re: Lamictal - Strange heartbeat/Anxiety, posted by bimini on July 29, 2008, at 10:54:39
I just upped to 25mg today - 10 days at 12.5. I did notice a temporary vision enhancement - seemed like I could see more detail. Also I seemed to focus on whatever I noticed, like walking by something I would really notice it and keep looking, & then my focus would shift to something else. It was a kind of being slightly stoned feeling. The slight initial feelings of being more alert & not trapped in my usual fog have returned this morning, although it is still early & it takes awhile for me to get functioning. I don't know what kind of hopes I have for the Lamictal - if it cuts my depression & anxiety in half I will probably be happy with that - I think I could function in the world at that level. I also was diagnosed years ago with mvp - I actually don't know much about it & how it can effect one - it has never been mentioned again by any doctors. I will drink plenty of water, always carry a bottle, but sometimes forget. I am a little confused about therapeudic dose, but I figure after I am on a particular dose for awhile & there is great enough improvement, I will stay there. Thank you, TH
Posted by annabamma on July 31, 2008, at 16:09:53
In reply to Re: Lamictal - Strange heartbeat/Anxiety » bimini, posted by Treehugger on July 29, 2008, at 11:55:25
> I just upped to 25mg today - 10 days at 12.5. I did notice a temporary vision enhancement - seemed like I could see more detail. Also I seemed to focus on whatever I noticed, like walking by something I would really notice it and keep looking, & then my focus would shift to something else. It was a kind of being slightly stoned feeling. The slight initial feelings of being more alert & not trapped in my usual fog have returned this morning, although it is still early & it takes awhile for me to get functioning. I don't know what kind of hopes I have for the Lamictal - if it cuts my depression & anxiety in half I will probably be happy with that - I think I could function in the world at that level. I also was diagnosed years ago with mvp - I actually don't know much about it & how it can effect one - it has never been mentioned again by any doctors. I will drink plenty of water, always carry a bottle, but sometimes forget. I am a little confused about therapeudic dose, but I figure after I am on a particular dose for awhile & there is great enough improvement, I will stay there. Thank you, TH
Hello-Uh MVP??? I assume that stands for mitral valve prolapse??? If it does- you should read up on it because there's a whole MVP 'syndrome' that can go along with it!!For such a (usually) benign problem,you can sure feel crappy and have all sorts of scary heartbeat / arrythmia issues.If you've got those kind of problems you've got to be careful with meds and even sometimes,caffiene.MVP is often related to anx./panic disorders,etc. I've had problems with all this for the last 30 years or so and hopefully am finally 'growing out of it'-my body is getting less adreneline sensitive.Good luck!
Posted by Treehugger on August 3, 2008, at 13:23:20
In reply to Re: Lamictal - Strange heartbeat/Anxiety, posted by annabamma on July 31, 2008, at 16:09:53
Annabamma - thank you - I did look up mvp syndrome, and it is certainly interesting. Maybe 10 or 12 years ago I was told I had mvp when I had some kind of heart test. If it could be the cause there doesn't seem to be much one can do other than consider it to exist, so as to not be so upset by the symptomes. I drink too much coffee, but didn't consume when the arrythimias first started. The Lamictal - I am not very hopeful anymore - after the 10 days of 12.5mg, and now 5 days 25mg, I started getting depressed yesterday. This morning I woke up in bad shape, very hopeless, tired. It hasn't had time to work yet, if it is going to. Unfortunately it looks like there a few negative posts today which I will read next - I just wanted to get back to you and thank you for your observation - for even paying attention to my post - I haven't had much luck in the past with babblers responding to me. Maybe I am not putting things out there the best, but not easy when I feel so bad. Thanx again, TH
Posted by mjbogdanov on August 3, 2008, at 19:23:56
In reply to Re: Lamictal - Strange heartbeat/Anxiety, posted by Treehugger on July 24, 2008, at 12:17:21
> Hi - I started Lamictal 7 days ago, 12.5 mg per day (drug sensitive so going slow) I felt an initial postive response for a couple of days except for sleeping less & feeling a little agitation. Last night I had - I'll call it a panic attack, & took .5 Xanax which worked. It is fairly common for me to have periods of arrythmia, but it has gotten worse, & my hands were actually (left hand) trembling, fingers jerking, last night. Feeling agitated & a little manic a lot of the time, & butterflies (big ones) high in my stomach. I do not have a diagnosis of bipolar, just SAD & depression. My rapid cyling led me to want to try Lamictal thinking I might be bipolar 2 - I also take 1mg. Clonazepam & .25mg atenolol a day. So - I am concerned about upping dose which I was going to start tomorrow - 50mg, fearing the side effects will get worse. I would like to hang in there, but not sure I can. No sign of rash. I guess I am looking for some encouragement to continue, or advice if it sounds like this is not a good med for me. TH
Hi Tree;
I have had problems trying to go up with the lamictal. The heart palps and pounding bothered me the most. When I read your post it reminded me of my initial titration. I felt a little manic, wasn't sleeping and was very agitated. I lowered my dose back down to 25 mgs. I was however somewhat less depressed so I didn't taper off entirely. I read with great interest the message that came as the initial reply in this thread from SLS (Scott, I believe.) If it weren't for his post, I would have given up. I have done a ton of reading about dysautonomias (a term I had never heard before.) I just read the post re mvp(syndrome.) There is food for thought there as well, especially in my case. All I can tell you is that my experience with lamictal has been similar and that it does seem I am still cycling. But I am going to try to stick it out and slowly make my was past the side effects (I hope) and reach the fabled "sweet spot." I am now taking Rozerem for sleep and that seems to be working for now. I'm at 75mgs so far. I still have lots of mvp/dysautonomic symptoms but from the reading, I understand that they are not as 'life-threatening' as I had originally thought which has calmed me down a bit. I have also made a concerted effort to stay hydrated. This has helped a lot. I actually didn't realize how dehydrated I was, and the more I drink, the better I feel. Sorry you are feeling so bad but do try to stick it out. I sometimes feel like such a lump (still have no energy) but I find I am at least able to do something where, before the lamictal, when I felt bad I was unable to push myself to do anything at all. I sometimes feel a little flat but find when I get going, there really is something there. I am going to visit with a cardiologist in a week and hope to try some beta-blockers to help with the adrenaline sensitivity. Will try to keep you updated re my progress. Please feel to send me a message anytime as I am hoping we will both be better with this effort. I have been on a billion different AD's and finally someone figured out I'm BPII. Keep in touch. Madeleine
Posted by Treehugger on August 4, 2008, at 14:05:30
In reply to Re: Lamictal - Strange heartbeat/Anxiety » Treehugger, posted by mjbogdanov on August 3, 2008, at 19:23:56
Madeleine, hi - I just dropped back this morning to the 12.5. Slept lousy, weird dreams, agitated & feeling angry, agitated. In the middle of the night I took .5 Xanax, slept for awhile, but it didn't do the trick. Also I am also so physically addicted to Clonazepam that I don't want the same thing to happen with X. So yeah, not so hopeful. I do know what you mean, true for me also - I have been able, sometimes, to move past that place, and get something accomplshed - or at least I start it. But there were times, even recently before Lamictal that I got lots done - I just seem to cycle so fast & more down than up - so I don't want to give credit to Lam yet. I will just keep going for a bit, make the decision later about stopping completely. I thought I would taper off at the same pace that I moved up. I haven't been diagnosed with Bi II, it just made sense to me, and the not so knowledgeable doc at the clinic went along with giving this a try. The mvp thing - yes it is interesting! Yes drink lots of water, but it's not an elixer - I carry a bottle with me everywhere - always! Also I would like to know how you do with a beta blocker if you start - for me, beta blocker, clonazepam = even more tired. Take care M, TH
Posted by mjbogdanov on August 4, 2008, at 14:49:39
In reply to Re: Lamictal - Strange heartbeat/Anxiety » mjbogdanov, posted by Treehugger on August 4, 2008, at 14:05:30
Hi again Tree;
Sorry things are not happening for you. This whole thing just sucks the life out of me sometimes. The anxiety does me in either outright or via slow burn and the depression incinerates. I'm 45 and wonder if I will ever get to enjoy my life before it's over. All this to say that I really feel for your struggle. Thinking of you while you try to figure things out.
There is also a thread called 'Is Lamictal Stimulating?' that you might look at. It seems that Lamictal can fry you at first but it's short lived, have to get over that hump so to speak. It really did that to me when I tried to ramp up too fast. I felt manic, was manic. Not so now at 75 mgs but have crept up much more slowly. I'm really trying to cope this time because I'm pretty much out of options as I've tried everything else! Will things work?? Don't know but am keeping the faith for now. Will advise re the beta-blockers. Take care.
Posted by Treehugger on September 3, 2008, at 1:16:22
In reply to Re: Lamictal - Strange heartbeat/Anxiety » Treehugger, posted by mjbogdanov on August 4, 2008, at 14:49:39
mj - would you update please? tree
This is the end of the thread.
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