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What causes headache, trouble sleeping, irritability and inner restlessness while on Lamictal?

Answered by
Dr. Alexander H. Sheppe


Practicing since :2014

Answered : 2243 Questions

Posted on Wed, 4 Nov 2015 in Mental Health
Question: I am having problems with Lamictal, which I have been taking with an SSRI for mood for 10 years...

Before I was moved to a generic, the lamictal helped greatly with mood, motivation, and social anxiety. It also helped me to lower my SSRI which had a lot of nasty side effects. The side effects included headaches, a busy brain/inner tension, and trouble sleeping, reading, and focusing.

Many of these faded when they put me on a generic version, but it has been creating more depression, obsession, and lot's of suicidal thinking. It also makes me feel very stupid and tired within a few hours of taking it.

A month ago I switched back to the brand name and I haven't had a suicidal thought since, however, the sleeping problems, irritability, and inner restlessness has returned. I'm feeling kind of trapped. I added Ritalin for a few days and it helps with the irritability and restlessness and focus, but it's making me nervous.

Do I have any options here? I feel trapped between suicidality and racy irritability.


Answered by Dr. Alexander H. Sheppe 2 hours later
Brief Answer:

Detailed Answer:
Thanks for your question.

First, brand-name drugs do differ from generic drugs in some ways. The generic drug can have a significantly less amount of medicine in it (up to 20% less), so your decision to stick with brand-name drugs is a good move here.

Second, regarding your symptoms of sleeping problems, irritability, and inner restlessness while taking the SSRI, my recommendation is to stop the SSRI and consider an atypical antidepressant such as Wellbutrin or Remeron. SSRIs in the treatment of bipolar depression in large-scale clinical trials have been shown to be NO MORE EFFECTIVE than placebo. Additionally, they create hypomanic side effects identical to the ones you describe. If I were your doctor, I would stop the SSRI and switch to an atypical antidepressant.

If atypical antidepressants don't work, I would consider an atypical neuroleptic such as Abilify, Latuda, or Risperdal.

My name is Dr. Sheppe, and I am an XXXXXXX psychiatrist working in New York City. For a personalized comprehensive evaluation, treatment recommendations, or individual therapy, ask me at HealthCareMagic at this private link: XXXX

Above answer was peer-reviewed by : Dr. Neel Kudchadkar
Follow up: Dr. Alexander H. Sheppe 29 hours later
thank you Doctor:

so, to clarify, I have not been diagnosed bipolar, although both my father and sister have. Unfortunately we are working more from a "how are your current meds feeling" stance than one based in a firm diagnosis. It is likely depression/general and social anxiety/PTSD/ADD and maybe borderline personality.

I am EXTREMELY med sensitive. I have been on Celexa or other SSRI's since 1997 with a few breaks here and there. They actually do help with anxiety and depression quite well but I'm not willing to take them at the dosages that completely relieve my symptoms. They numb me out completely and make me very prone to impulsive behavior and substance abuse. The latter is why we added Lamictal when it first came on the market in hopes of calming the impulsive drive from the celexa. I won't retype my reaction from above but it did help in many ways but cause some bad side effects.

The worst of which was this constant brain chatter/raciness and difficulty concentrating, reading, doing math, etc. It killed my sex life for years. I thought all the racy ruminations that prevented me from being intimate was a trauma response, but after lowering the lamictal and changing brands (and then back in the past week) I realize it was this distracted business in my head from the lamictal.

I've tried most of the others:

Prozac...similar to celexa but more numb and prone to panic
Serzone...prone to anger and sadness. Not that effective for depression. Ok for sex drive though

Wellbutrin: tried it once with serzone and it made me very racy and angry.
tried it twice with Celexa to reverse sexual problems and also to improve concentration. Felt good for a few days...then angry, sad, and depersonalized.

Desipramine (alone): Good concentration but more depressed. Only took it three days.

Risperdal with Serzone: Felt emotionally open and not beholden to everyone around me for a few days, but then more and more busy head, strange, culminating in akasthesia. One of the worst feelings ever.

Celexa alone: Lifted depression and anxiety well, but too numb, impulsive, sexual SEs

Celexa and Lamictal (see above)

Celexa and Lamictal and buspar...did AMAZINGLY for concentration, reading, interpersonal fear, IBS, tightness in throat...for a couple of weeks until it created uncontrollable fits of rage for no reason. Could lead to precipitous depressions at time. Every time I tried to get back on it I would get so annoyed by having to be around other people and listen to them talk. Grrrr

Celexa and Lamictal and klonopin (my current regimen). Klonopin helped concentrate and sleep some, but may have brought about suicidal bouts. never more than .5 mgs in a day.

the above plus tired and apathetic

the above plus Seroquel...helped with interpersonal situation and dating but only initially. Then felt detached and zoned out/drop in cognitive skills

the above plus Latuda....same as above, not as severe and cognitive skills increased. Daily headaches. Some sleeping problems.

the above plus ritalin (only 5mgs ER)...helped with mood and sometimes sex drive, but could also feel awful the next day until I took it again. Not that great for concentration unless paired with more klonopin to offset the edginess. Spiked my blood pressure and is dangerous for scuba diving. Also made me feel "drinky" and then I would become an utter monster and do things I wouldn't otherwise imagine.

Brintellix, Lamictal, and klonopin?: Initial help with anxiety and sex drive. Very soon felt very apathetic (and not in a depressed way, just disengaged from everything).....Added vyvanse, which helped the apathy but I didn't feel great being on a stimulant. It created some impulsive behavior too. Adding about 5mgs of celexa to this mix would also help the lows and apathy.

Viibryd lamictal klonopin: much better with mood than Brintellix with some of the good antianxiety effects of the 5ht1-a agonism. Made me unspeakably tired and somewhat detatched.

Zoloft, lamictal, klonopin: Much like buspar in its anxiety profile (both physical and interpersonal) and for concentration. Again, bad irritability and detachment feelings after not very long.

Sooo...I am currently taking classes and doing grad school interviews for PA school while running my own business, so I need to stay functioning. My pdoc says the only way for a "clean" diagnosis is to take me off everything which isn't really an option with all I have going on. I'm not very comfortable in her care in that she writes a script for whatever I want and, while I am educated and advocating for myself I don't feel like I should be directing everything that happens. Also she disappears for days at a time with lame, fake excuses and misses 80-90 percent of our appointments. I'm not exaggerating. I have medicaid some I'm a little stuck.

Now that I've returned to the original Lamictal and increased my celexa back to 10-15 mgs, I haven't had the day long suicidal ideations that would follow my morning dose of Lamictal. My mood is good but my sleep is not and this racing lack of concentration has been increasing over the last week and gets worse as the day wears on. So far I've found that ritalin helps to rein it in. After a school interview on Friday we might try damping down the raciness with a small dose of Brintellix, using it as an augmentor...hoping for the anxiolytic effects of the buspar without the anger; and without the apathy that taking just the Brintellix brought about.

This is the tightrope I've been on for five years now. Not even sure what I'm looking to achieve...therapy really isn't very effective but I know that I'm thoroughly obsessed with my meds.

Anyway, I've gone on a tear because I have someone listening that might "get it" and have a different perspective. I'm paying for unlimited monthly service but I know this is involved so if you think you can offer something insightful I could move to your more comprehensive program.

needless to say I'm very well versed with most psych meds, their modes of action, etc., so I prefer comprehensive answers over generalized one...thanks!
Answered by Dr. Alexander H. Sheppe 6 hours later
Brief Answer:

Detailed Answer:
Thanks for clarifying and typing out this extensive history.

As you say, this is incredibly involved. There's a lot of information here and I've gone over it in detail. I do have several insights, but I think it would be more appropriate for us to discuss this in my more comprehensive program. There I can really give you the focus and attention you deserve.

Write me a direct question at my private link and we'll get started working on this very complex case together.

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj

The User accepted the expert's answer

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