What causes mood swings after taking Lamictal?

Posted on Wed, 16 Dec 2015 in Hypertension and Heart Disease
Question: Last night was probably the fifth night (not consecutive) in the past month that the following has happened:

About around bedtime, usually after a high-carb meal, I feel like my body is being flooded with adrenaline...my heart starts pounding, I feel agitated, cannot sleep, stomach pains, headache, and I feel overheated. It lasts almost all night.

The first time it happened was my second night after a very low-carb diet (21 days of minimum carbs) and I ate a lot of pasta salad. I had also just switched HIV meds from Atripla to Triumeq several nights before.

Also since that time I"ve had the following symptoms, which may or may not be related:
cold hands and legs
muscle weakness
daily headaches
Depression and Rapid mood swings (often dependent on food)...depression will go away almost immediately with food and/or coffee, sometimes ritalin.

I exercise 3 times per week and eat well. I also have no history of elevated blood sugar. I I have a family history of bipolar and I take 15 mgs celexa and 150 mgs lamictal, and .25 mg klonopin but I've never been diagnosed with BP. I have NEVER had rapid mood swings since before starting lamictal.

I am specifically worried about the following things:
Should I be worried about my thyroid with the pounding heartbeat and food-regulated mood swings?
Should I be concerned with lactic acidosis (from the HIV meds?)
What role is the lamictal playing? I remember having these mood swings that respond to food after decreasing my lamictal dose or changing manufacturers.

Answered by Dr. Ilir Sharka 1 hour later
Brief Answer:
I would explain as follows:

Detailed Answer:

Thank you for asking on HCM!

I understand your concern and would explain that it is important to perform a careful differential diagnosis of different causes that may mimic this clinical scenario.

Your clinical situation seems to be a little complicated and the therapy you are taking seems to play an important role to your symptomatology.

You should know that Lamictal is an antiepileptic drug, also used in mood disorders. Anyway it has not a big effect in mood disorders. It can be related to adverse effects such as: insomnia, anxiety exacerbation, abnormal thoughts, hot flashes, etc.

Lamotrigine increases toxicity of citalopram by pharmacological interaction. So its use and the change of doses could lead to citalopram toxicity and possible serotoninergic syndrome, enhancing psychomotor agitation.

We should also take into consideration the drugs you are taking for HIV and their side effects.

Ritonavir (Norvir), an antiretroviral medication used to treat HIV/AIDS could also lead or exacerbate serotoninergic syndrome.

You should know that serotoninergic syndrome is associated to flushing, psychomotor agitation, possible diarrhea, etc, which could be exacerbated by food intake.

From the other hand ritalin is a central nervous system stimulant, which can also induce anxiety, tachycardia, agitation, etc.

But an endocrinological disorder such as a thyroid gland dysfunction or a adrenal gland dysfunction could also mimic this clinical situation.

You should know that these glands are very important in the metabolization of glucose and a high sugar diet, could induce certain inappropriate body reactions, when the function of these glands is impaired.

We should also take into consideration the drugs you are taking for HIV and their side effects.

I would recommend to closely monitor your blood pressure during the day (in sitting position after 10 minutes of total relax) and refer those values to your doctor.

So I would recommend performing some tests coupled with a careful physical examination:

-resting ECG
-chest X ray study
-blood lab tests (complete blood count, thyroid hormone levels, cortisol plasma levels, PCR, sedimentation rate, kidney and liver function tests, blood electrolytes, blood gas analysis, etc.).

I recommend discussing with your doctor on the above issues and the possible changes to your actual therapy (reduce the doses of lamotrigine or celexa or switch to other drugs).

Hope to have been helpful!

Feel free to ask any other questions, whenever you need!

Best regards!

Dr. Iliri
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Answered by
Dr. Ilir Sharka


Practicing since :2001

Answered : 7222 Questions


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