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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by thegron on August 18, 2012, at 18:17:32
Hi,
I am new to this site and I'm hoping to get some helpful feedback on what I am currently going through
I'll try to make this post as succinct as possible.
I am a fairly healthy 22 year old male who was recently put on lamictal a little while ago to see if it would help reduce some of my anxiety. As an aside: my anxiety is pretty bad but has never impaired me cognitively in any way. I took 25mg of lamictal for two weeks and then upped the dose to 50mg. About 6 days into my 50mg week, I started to, all of a sudden, feel very DUMB. I realize that this is a baby dose of lamictal but I have a very very sensitive body and respond to medications at fairly low doses. This cognitive impairment slowly worsened over the course of that day and even got a bit worse the next day. After that it sort of plateaued. My Psychiatrist told me to lower the dose back to 25mg. I lowered the dose and stayed at 25mg for a couple of days with no symptomatic improvement. He then told me to discontinue the drug. I did so, and it has now been 6 days and I do not feel any better. This is alarming as I am starting Pharmacy school (memory intensive) in less than a week. I need my brilliant brain back!!!Anyhow, I have heard many people say that it took a week, even months to feel normal. I have even heard people (only a handful) say that they never fully recovered. As you can imagine, my anxiety disorder is not helping me think about this clearly and I am in desperate need of support.
What would be most helpful to me is, for you people out there who have experienced this, to let me know how long it took for you to feel better.
-Thegron
Posted by jane d on August 19, 2012, at 0:21:44
In reply to Lamictal cognitive impairment reversible?, posted by thegron on August 18, 2012, at 18:17:32
I had memory problems. I only took Lamictal for a few months. When I stopped the memory problems went away.
Posted by thegron on August 19, 2012, at 0:47:57
In reply to Re: Lamictal cognitive impairment reversible?, posted by jane d on August 19, 2012, at 0:21:44
> I had memory problems. I only took Lamictal for a few months. When I stopped the memory problems went away.
Hey jane,
Thanks for your reply. How long did it take for you to feel better? The day after you stopped the meds? 2 weeks after? A month? Also, did you all of a sudden feel better or did you slowly improve?
sorry for all of the questions but the specifics will really help me.
-Thegron
Posted by phidippus on August 19, 2012, at 1:34:47
In reply to Lamictal cognitive impairment reversible?, posted by thegron on August 18, 2012, at 18:17:32
Lamictal raped me over and over. It worsened my OCD and made my brain slow to a crawl. It took a month after stopping the medication to get back on track. I wouldn't pay much heed to the horror stories regarding permanent loss of cognitive ability as many are highly dramatized. Your mind will clear, but the key is getting back on track with treatment that is sensible-new treatment also increases the likelihood of reversing Lamictal's effects.
I've been battling anxiety for many years now and I hope I can point you in the right direction medicine-wise.
When battling anxiety, the key is understanding that serotonin plays a major part in anxiety-the less you have, the more likely you are to be anxious. Serotonin acts like a messenger to various parts of the brain that become activated and create anxiety, telling them to shut off. Increased serotonin also lowers Glutamate in the brain-glutamate is an excitatory chemical which causes anxiety, among other things.
To begin your battle, I would recommend an antidepressant as your first line of defense. I say first line because it is very common to have to treat anxiety with multiple medications. Once you have the foundation of an antidepressant, you have a wide variety of medications you can turn to to augment your treatment.
For anxiety I would recommend the following antidepressants:
Elavil
Clomipramine
DesipramineZoloft
Luvox
Paxil
Viibryd (my personal favorite because it is a 5ht1a partial agonist, which gives extra kick in treating anxiety)Mirtazapine
Once you have that antidepressant on board, you're going to have to wait a couple months for the drug to take full effect-while you're waiting, have your doctor prescribe you a long lasting benzodiazapine to fight off the anxiety in the meantime. I like Librium, Clonazepam or Valium.
You may find after a couple months your anxiety under good control, which means you may not have to switch up anything, maybe lower the dose of your benzo, but that's about it.
Of course, your choice in antidepressant might not be goodd enough, in which case you might have to go on a hunt to find the right one. This can be a painstaking process, but that's kind of how it goes treating anxiety.
If the AD and the benzo aren't treating your anxiety sufficiently, there's a line up of drugs that can help:
Lyrica
Prazosin
Keppra
Gabitril
Gabapentin
Clonidine
Buspar
TopomaxI hope this hasn't been to lenghty-I'm just hoping to help.
Let me know how things progress.
Eric
Posted by SLS on August 19, 2012, at 3:09:59
In reply to Lamictal cognitive impairment reversible?, posted by thegron on August 18, 2012, at 18:17:32
After being on Lamictal at a dosage of 300 mg/day for four years, the cognitive impairments that it produced resolved immediately upon a dosage reduction to 200 mg/day. My thoughts were clearer within 48 hours.
- Scott
Posted by SLS on August 19, 2012, at 3:30:16
In reply to Re: Lamictal cognitive impairment reversible? » thegron, posted by phidippus on August 19, 2012, at 1:34:47
I think that an increase in synaptic concentrations of serotonin can have variable effects, depending on the extant balance of 5-HT receptors and the routing of the circuits they modulate. Lexapro can produce anxiety as well as quell it, depending on the individual taking it. Quite often, Lexapro increases anxiety early in treatment (about day 14) and decreases it thereafter. Prozac can produce anxiety in some people and not in others. Perhaps this is the result of interindividual differences in the sensitivity of 5-HT2c receptors. Glutamate can be excitatory upon dopamine circuits or inhibitory upon them, depending on what brain structure is being acted upon. It might excite certain structures in the dorsal striatum, but inhibit others in the ventral striatum (nucleus accumbens).
- Scott
Posted by Phillipa on August 19, 2012, at 9:53:12
In reply to Re: Lamictal cognitive impairment reversible? » phidippus, posted by SLS on August 19, 2012, at 3:30:16
Prozac was very stimulating and couldn't take it. As for the others seems I'm stuck on 50mg of luvox and benzos. I often wonder what would have happened had that pdoc left me alone on 200mg of luvox second ad ever with ativan as felt great. Unfortunately to switched me to celexa for a trial. Oh well but it was the only ad no side effects from. Hence remain on 50mg and 2.5mg of lexapro I'd stopped for over a month and may again do. I don't know what lexapro does for me. Could be age as old now. I think since you are very young that you will find a great treatment. And also welcome to babble. Phillipa
Posted by thegron on August 19, 2012, at 16:30:05
In reply to Re: Lamictal cognitive impairment reversible?, posted by Phillipa on August 19, 2012, at 9:53:12
phidippus,
thanks for your replies. Unfortunately, I cannot take any medication with binding affinity to the 5-HT1a receptor. I have some hypersensitivity autoimmune reaction to them and repeated attempts to take zoloft, prozac, buspar, etc. have left me with severe hyperchlorhydria (acid dyspepsia). I am working with a GI doctor to figure out what the heck happened to me... anyway, they have really f'ed me up. most serotonergic medications act on the 5-HT1a receptor, therefore, i only have a limited number of medications to choose from. that is why I have tried many off-label meds for anxiety. the only meds that have ever worked for me have been benzodiazepines (no longer take them because they caused long lasting cognitive dysfunction) and hydroxyzine (because it only binds to the 5-HT2a receptor). mirtazapine is one of the few AD's that does not bind to the 5-HT1a receptor but for whatever reason, after 6 weeks at 45mg, I felt nothing...
boy i hope my head clears soon....
-Thegron
Posted by schleprock on August 19, 2012, at 17:08:59
In reply to Re: Lamictal cognitive impairment reversible? » Phillipa, posted by thegron on August 19, 2012, at 16:30:05
Is it worse than Klonopin?
Posted by thegron on August 19, 2012, at 17:32:48
In reply to Re: Lamictal cognitive impairment reversible?, posted by schleprock on August 19, 2012, at 17:08:59
It's different. Both are pretty bad. Lamictal's effects are more long lasting imo. And I still feel like sh*t after a week off the drug... wtfffffff
Posted by phidippus on August 19, 2012, at 17:35:42
In reply to Re: Lamictal cognitive impairment reversible? » Phillipa, posted by thegron on August 19, 2012, at 16:30:05
You're going to have a rough battle ahead of you.
Have you tried Lyrica?
Eric
Posted by thegron on August 19, 2012, at 18:10:46
In reply to Re: Lamictal cognitive impairment reversible? » thegron, posted by phidippus on August 19, 2012, at 17:35:42
haha yeah well its already been a rough battle the last four years. im used to the daily suffering by now :(
i actually recently tried lyrica but it caused more cognitive dysfunction. i seem to be really sensitive to any change in cognition.
what do you think about trying mirtazapine again but this time at a higher dose? (90mg or something)
also btw, going back to my original post about the weird brain fog/memory problems with the lamictal: the night before i started to experience the symptoms, i took some lyrica. idk if it could be the cause of this but i guess its unlikely as i only took it a few times and always in tiny doses (25 or 50mg). idk. ive also been thinking my symptoms could be related to the zantac i take every night because i started taking it just 2 nights before i experienced the brain fog... im not going to take it tonight and see what happens.
-Thegron
Posted by phidippus on August 19, 2012, at 19:42:01
In reply to Re: Lamictal cognitive impairment reversible? » phidippus, posted by thegron on August 19, 2012, at 18:10:46
You know, a lot of the cognitive impairment you seem to experience on these mediccations is something that will go away after awhile.
Why do Remeron at 90 mg? You're not going to get much more therapeutic benefit.
Have you tried Keppra?
Eric
Posted by thegron on August 19, 2012, at 20:05:41
In reply to Re: Lamictal cognitive impairment reversible?, posted by phidippus on August 19, 2012, at 19:42:01
I have read (even on these forums) that some non-responders respond to higher doses of mirtazapine. I figure theres not harm in trying it.
Yeah I mean, if I had stayed on the lamictal, it is possible that after a few months on a steady therapeutic dose, I would have felt better. however, im starting Pharmacy school in a week and theres no way I couldve dealt with the cognitive dysfunction (even tho it doesnt seem to matter now because I have it anyway...) lol.
I have thought about trying keppra because I have heard it does not cause dysfunction (i love racetams!) and it can be helpful as an anxiolytic.
do you have any personal experience with keppra?
by the way, i found a thread on another site where a couple folks stated that it took months for their lamictal brain fog to go away after discontinuation of the drug.
http://www.crazyboards.org/forums/index.php/topic/44511-quit-lamictal/
-Thegron
Posted by phidippus on August 19, 2012, at 22:32:49
In reply to Re: Lamictal cognitive impairment reversible? » phidippus, posted by thegron on August 19, 2012, at 20:05:41
Keppra actually improved my cognition. I found myself more alert and just a bit quicker.
The trick is finding the sweet spot in the dosing-go too high and it causes anxiety.
I was comfortable at 2000 mg for a couple of months.
If you do the Mirtazapine, I'd take 60 mg if I were you.
Have you tried Prazosin?
Eric
Posted by thegron on August 19, 2012, at 22:58:02
In reply to Re: Lamictal cognitive impairment reversible? » thegron, posted by phidippus on August 19, 2012, at 22:32:49
interesting. ill have to try it soon. im probably going to wait for this lamictal cognitive stuff to die down before i try anymore drugs lol.
did u take the keppra for anxiety? or for depression? or bipolar? im just wondering what its effect was for u on anxiety/depression. ive heard that even though it is primarily an anti-convulsant, it can be used as a mood stabilizer too.
ive never heard of prazosin. looks interesting. so its a sympatholytic... does this mean it would only help with the physical symptoms of anxiety or would it also help with the mental symptoms?
yeah i would def try 60mg of mirtazapine for a while before i went any higher.
thanks for your continued help.
-Thegron
Posted by phidippus on August 19, 2012, at 23:49:54
In reply to Re: Lamictal cognitive impairment reversible? » phidippus, posted by thegron on August 19, 2012, at 22:58:02
I took Keppra to treat my OCD, which it did a fantastic job of. It can be used as a mood stabilizer, but I've only come across one study showing its efficacy.
Keppra initially had a stigma about it causing depression, but those were early studies, since its been shown to cause depression as much as any other anticonvulsant.
>im probably going to wait for this lamictal >cognitive stuff to die down before i try anymore >drugs
I'd get on a new drug the sooner the better.
Prazosin works on an emotional level as well. It really works well for panic symptoms.
How about Gabitril? Have you tried it?
Eric
Posted by thegron on August 20, 2012, at 8:56:31
In reply to Re: Lamictal cognitive impairment reversible? » thegron, posted by phidippus on August 19, 2012, at 23:49:54
Hmmm... ill def get keppra when my psychiatrist gets back from vacation. i wonder if i could combine it with prazosin?
yeah ive heard of gabatril but it has been known to cause cognitive effects so im afraid to take it. i swear, if a med has been known to cause cog effects in some people, im always one of those people. ;(
-Thegron
Posted by phidippus on August 20, 2012, at 11:02:53
In reply to Re: Lamictal cognitive impairment reversible? » phidippus, posted by thegron on August 20, 2012, at 8:56:31
I would give Mirtazapine another try and augment it with the Keppra.
Here's some articles on Keppra:
http://www.ncbi.nlm.nih.gov/pubmed/18707022
http://www.ncbi.nlm.nih.gov/pubmed/19888964
All you ever wanted to know about Keppra, haha.
And yes, you could take all three-Keppra,Mirtazapine and Pprazosin if you wanted, however Mirtazapine and Prazosin would be competing at the same sites (I think).
Eric
Posted by thegron on August 20, 2012, at 12:08:20
In reply to Re: Lamictal cognitive impairment reversible? » thegron, posted by phidippus on August 20, 2012, at 11:02:53
Thanks! haha. time to do some reading!
yes ill probably try the mirtazapine again and augment with keppra. btw i checked on prazosin, apparently it would be synergistic with mirtazapine bc they both act antagonistically on the alpha-1 receptor.
-Thegron
Posted by alchemy on August 20, 2012, at 18:48:54
In reply to Re: Lamictal cognitive impairment reversible? » thegron, posted by phidippus on August 20, 2012, at 11:02:53
> I would give Mirtazapine another try and augment it with the Keppra.
>
> Here's some articles on Keppra:
>
> http://www.ncbi.nlm.nih.gov/pubmed/18707022
>
> http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000277/WC500041331.pdf
>
> http://www.ncbi.nlm.nih.gov/pubmed/19888964
>
> http://www.ninds.nih.gov/research/parkinsonsweb/cinaps/Compound%20Dossiers/Levetiracetam%20dossier.pdf
>
> All you ever wanted to know about Keppra, haha.Hi Eric,
Keppra is one med I haven't tried, I have some hesitance. There seems to be a higher percentage of people where it makes them more depressed than others. And I already have most meds make me more depressed. I am not ruling it out, but when/if I try it, it is nice to have some positive references.
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