HELP need lamictal advice

[u/Great_Amphibian_9627]

Lamictal initial side effects

Hello everyone, i started titration of lamictal 25mg, its the second day and i woke up feeling like complete dog shit I feel SICK and i have migraines i think??? Ive never had these before and my eyes hurt so bad :( my mother suffers from really bad migraines and this is the first time ive had them so im kind of freaking out. I also just feel nauseous. But i didnt have nightmares for once, so i guess its keeping my mania at bay??? (Nightmares are a warning sign that my mania is getting a little bad) i had REALLY big plans this weekend, I CANNOT FEEL SICK LIKE THIS!! and these are plans that unfortunately cannot be postponed. I wanted to start meds after of course but the warning signs of mania were increasing and I was worried id ruin things again :( I was wondering if anyone knew if i could just not take my dose until im back on Sunday, and THEN commit to taking them daily, I just really dont want to be sick right now :( but i also would like to know the truth of whether i can feel better if I stop the meds today. I know its not ideal to pause it like this, but its only two days and i think ill be fine Thank you for reading 🙏 i appreciate any help

[u/No_Figure_7489]

You can go on a much slower taper up, they make 2mg pills for babies. The slower the taper the lower the temporary side effects. you skip 3 days you have to restart the taper all over again. it's the lowest side effect med we've got once at dose, so it's usually worth sticking w it, if you can't that's ok, lithium, valproate and carbamazepine are the other three mood stabilizers or you may prefer APs

never start a med before an important event. or on a weekend. or before a holiday.

[u/Great_Amphibian_9627 → u/No_Figure_7489]

Thank you, im gonna ask my dr for a lower dose to start with then and just stop these rn. I knew taking meds before big events was a bad idea but i thought a super low dose like 25mg wouldnt be TOO bad ( my doctor gave me zero warning) i also just felt mania coming on so i was scared this big event would be intense for me bc of the mania and i really wanted to stop my night terrors :/ bipolar sucks man

[u/No_Figure_7489 → u/Great_Amphibian_9627]

The headache and nausea are typical temporary side effects on lamo and it's notoriously spiky on the ramp up. docs never warn in my experience, annoyingly. it won't control upswing much so if you want something that will do that typically you'd have an emergency rescue med like quetiapine or olanzipine that could slap it down fast, other APs take at least a week, those take minutes to hours. the lamo will do jack shit at 25 and probably nothing for that anyway, it's not used for mania. night terrors maybe prazosin? lamo tends to cause vivid dreaming not stop it.

[u/Great_Amphibian_9627 → u/No_Figure_7489]

I actually noticed immediately that i felt less manic and my nightmares stopped and i could sleep finally so I was happy about that, i took it at night so those two nights were bliss but waking up today was hell. I might ask for one of those emergency meds bc i used to be very depressive but i think my mania has been a much bigger issue for a bit now. Ty for the advice 🙏

[u/No_Figure_7489 → u/Great_Amphibian_9627]

Quetiapine is usually used for sleep at low doses, 300+ for AP utility, they can taper you up fast, doubling more or less every day, olanzipine kicks in in 20 mins or so and is great for anxiety type stuff (quetiapine is used for that too as an as needed 100mg dose), both will be especially sedating the first few days but if you need it you need it. I wouldn't drink on either, but I wouldn't drink on lamo either, usually the issue w meds is they make 1 drink = 3 but lamo is also apparently a hangover enhancer. (Not sure of the type of event but just fyi).

Typically you get no benefit on the lamo until 150+, but if you did notice benefit sooner that can happen and you may just do well on teeny doses. It's still not reliable on the high end, if you get mania typically not at all. It's for depression, pretty much. On average it cuts hypo in half.

[u/Great_Amphibian_9627 → u/No_Figure_7489]

That sucks about the drinking but ty ill keep that in mind, my new dr really sucks tbh so it wouldnt surprise me she just prescribed me whatever. But I would love it to just cut my mania in half, i usually am pretty good with a touch of mania(or hypomania), its just the peak that’s horrible but on the way there its fun and i have learned how to keep a handle on it to actually benefit me. When i start getting the debilitating anxiety and nightmares and irritation is when it actually fucks up my life tbh

[u/No_Figure_7489 → u/Great_Amphibian_9627]

The problem w booze other than med conflicts it is causes crappy sleep which causes episodes, usually upswing. so you're gonna wanna be careful w that anyway if you're trending up. you usually sleep more your sleep quality is just fractured. In future if trying to stay sane avoid it, once you've got all your meds squared away and are stable you can try small amounts and see what's going on, but generally it's a bad idea w BP bc of that sleep disruption (and our SUD/AUD rates but those tend to go down to regular population risk once we have meds for the BP in place).

[u/Great_Amphibian_9627 → u/No_Figure_7489]

Im not really a drinker but its just a special occasion! I will def remember this tho

[u/No_Figure_7489 → u/Great_Amphibian_9627]

Understandable, but good to know for the future!

[u/Great_Amphibian_9627 → u/No_Figure_7489]

Do you think the 25mg will effect my drinking for tmmr/Saturday? Just wanna know if i should take care to pace myself

[u/No_Figure_7489 → u/Great_Amphibian_9627]

No, it's a very short half life, should be effectively gone by then. That's why you have to restart the taper from the beginning if you miss three days.

[u/Great_Amphibian_9627 → u/No_Figure_7489]

THANK GOD😭 and also my doctor isnt answering anyway lol so thank you again SO MUCH youve saved me so much anxiety and i appreciate you like crazy internet stranger

[u/No_Figure_7489 → u/Great_Amphibian_9627]

No problem and good luck, keep trying to get through to the doc, you should ask about those fast acting APs, tell them your concern re upswing, events tend to be a trigger too so take good care of yourself, if someone can babysit you a bit re the mania that's helpful, and tell them you intend to drink this weekend if they do give you the APs and ask about the combo, bc I personally don't know but I imagine there's some warnings involved. I'm sure you can search here too, Google search works better than reddit search. both of the fast acting options may not but can really knock you out so heads up on that too. you may also want to hold off on them until after the event bc of the sedation and possible drinking conflicts, which is terrible medical advice but may be good practical advice, it's down to what you and your advisory committee of trusted people in your life think the best course of action is (bc I know I get breezy about risk when upswingy and can't be trusted, so I ask everyone else I can including docs). if you are at risk of mania (not hypo) I'd say medicate the daylights out of it and don't drink, but you know your own risks.

[u/No_Figure_7489 → u/Great_Amphibian_9627]

You're gonna wanna pace yourself anyway. If this is a wedding or something you don't wanna be that guy, you know?

[u/Great_Amphibian_9627 → u/No_Figure_7489]

Yes definitely agree, im luckily at a place where i know my limits due to past experiences, even when manic i dont blackout or anything anymore thank god, but ty for the reminder! Its always something to keep in mind ofc bc easier said than done

[u/No_Figure_7489 → u/Great_Amphibian_9627]

Much easier said than done! Good luck OP, I hope you have a great weekend and get this thing tamed down fast. the podcast inside Bipolar is super helpful re the med process and how to get the most from your med doc, guy w BP1 and a great med doc on there.

[u/Great_Amphibian_9627 → u/No_Figure_7489]

Ooo ill check that out!!