Question: HI Dr. XXXXXXX I was directed from the regular forum. I hope you can see the questions. I am pasting a piece of the discussion about LAMICTAL as a starting point:

"Upon doing some experimentation, I have found that a lot of the unmotivated and withdrawn feeling, as well as obsessive thinking about persecution is coming from the lamictal. Right now I just take the Lamictal 150 mg and klonopin .25 mgs (I was taking celexa for many years but Doctor thinks SSRI is destabilizing.

I feel good in the morning before taking medicine. About an hour after taking my lamictal, I become sad and obsessively fight with people in my head over small problems or arguments that haven't occurred yet.

This is a consistent pattern but I know it is uncommon for Lamictal. I feel like I am over-stabilized and that my light-heartedness and drive are stripped away.

I really would like to stop taking this as I HATE feeling withdrawn and sad, but I know I shouldn't stop rapidly. Do you have experience treating people with Lamictal?"

...so now I still get the intense, defensive, "negative tape" running through my head about one hour AFTER TAKING LAMICTAL. I'm not sure that was clear. I know you said that Lamictal doesn't treat these symptoms well, I find Lamictal actually makes these symptoms worse, where I am somewhat paranoid and hypervigilant and setting myself against everyone in potential fights. These symptoms will not come during the day if I do not take my morning dose. That is not a long-term option. After four days of dropping down to only taking 100mgs/day of Lamictal, I became more depressed and found it difficult interracting with people and thinking. My therapist described me as becoming "dissociated."

I feel trapped on the Lamictal! I added LATUDA 10 mgs (as we discussed) three days ago hoping to address the paranoia and withdrawl, and maybe replace the Lamictal. Unfortunately it is causing horrible dreams, a drugged feeling, plus severe irritability and detachment around people. I almost feel like the people around me aren't real people and that scares me.

I think I want to stop the Latuda. In the past I have only taken it with an SSRI and had similar responses. In my experience it only gets worse as time goes on. What is your opinion about stopping, given my response?

Also, do you have any suggestions about the Lamictal? would the withdrawl and negative ruminations improve at 200mgs? Or is there something I can transition to?

For background: When I started it 10 years ago, it was added to Celexa because Celexa was making me feel impulsive and possibly hypomanic; The lamictal helped with motivation, social interaction, and self-possession; it did give me bad headaches, significant cognitive problems, and kept me awake most of the night. These side effects are much less without the Celexa.

Thank you very much for considering this complicated question! I have upgraded my membership and asked you directly because of your experience.

Kind regards,

thank you doctor:

I want to report what happened on my third day of Latuda yesterday. I am taking 10 mg before bedtime:

-I feel impaired and zombie-like during the day until I take Lamictal, which seems to clear me up somewhat. My drive for socializing, exercising, and hobbies has come back with Latuda, compared to just being on the Lamictal (a happy response!) but I still feel detatched and groggy. I feel more easy around people until the slightest agitation

and then:

Violent rage and impulses! I am a massage therapist and I quickly lost my temper and had an overwhelming urge to hurt at least one of my clients, and also kill myself. I had to leave the room and every second I spent stuck in the room was torture! I made them leave I was so angry. I had similar feelings the day before but they weren't as bad.

I am also having these violent tendencies during my dreams! Last night I woke up with terrible akasthesia and felt like I was going crazy long after being awake. I took 1 mg klonopin to get back to bed and canceled my morning clients.

I read that people who have violent/suicidal impulses on psych meds might have genetic dispositions for metabolizing certain drugs too fast or too slow. I am going to look into genetic testing. I also have PTSD from childhood abuse and I know this can result in hypersensitivity to meds.

I have had violent and disconnected thoughts around people on Latuda and VERY badly on Risperdal...both tiny doses.
I have also been driven into rage without cause by buspar, zoloft, and wellbutrin (but only mixed with seratonergics like serzone and celexa).

However, on the Latuda the past several nights I have had dinner with people and found no floating anxiety or constant distraction and monitoring which frequently ruins my relationships. I would like to keep that feeling of integrity without the intense foggy feeling or the desire to hurt people.

I'm curious about your Seroquel suggestion. 50mgs has made me feel extremely impaired in the morning. It did little for mood and motivation but was helpful with obsessive thinking. Isn't 200-300 mgs a high dose for my needs? I mostly need somehting with low-moderate mood elevation and motivation.

Let me be clear that I am a pretty high functioning professional with aspirations of going back to graduate school, and my bpII diagnosis isn't very clear-cut and clouded by a trauma background. I don't think I need heavier medications used for patients that are bedridden or having psychotic episodes.

I am terrified of the response I am having with latuda. What is happening there?
Also, isn't seroquel going to be too sedating given my response with latuda?

please advise and thank you so much!

thank you again. Two quick questions and then I will start a new thread if I have any more concerns:

-What happened with the violent/uncontrollable feelings with the latuda? I'd like to know if it was a psychological problem that I need to bring into therapy, or if it was an adverse biological response to the drug.

-Can I expect a return to motivation on the seroquel like I had with the low dose of latuda, or just an improvement in mood?