Am I losing my mind while trying to save it?

July 25, 2006 4:24 AM

What are the more serious side effects that can come from taking Lamictal?

I have just been placed on Lamictal after a prolonged struggle with bipolar disorder. I’ve hesitated going on it because of reports I’ve read of cognitive side effects including “fuzzier thinking,” memory loss and problems with word recall. I work in linguistics and am very concerned over this. I’ve searched bipolar forums and seem to see nothing but testimonials in relation to the drug, but 99% of the posts have the most atrocious spelling and punctuation mistakes that I’m beginning to wonder if I’m risking my livelihood by taking it! I know 99% of posters on Internet forums in general have atrocious writing skills (with the remaining one percent belonging to MeFites, of course), but still, I find it worrisome. Does anyone out there have any insight into this? Thanks in advance…

posted by anonymous to health & fitness (20 comments total)

I have not been on it personally, but someone close to me was on it for about a year, and the side effects were nonexistent. Uncannily so. So much so that she began to wondering if it was doing anything. Except that everything was normal, which was the desired result.

This was following some much more hi-test anti-psychotics like Risperdal and Zyprexa that had numerous noticeable and unpleasant side effects. Just one data point, but this is one of the sharpest people I know, and it didn't dull her one bit.
posted by Lazlo Hollyfeld at 4:44 AM on July 25, 2006

The lamictal is not going to make you stupid. The "fuzzier thinking" is reported by some patients, but it's actually kind of hard to tease out whether a given patient is just missing the faux-clarity of the manic phase. That said, many of the anticonvulsants used to treat bipolar disorder (including lamictal) can lead to mild cognitive slowing. We're not talking loss of IQ points, though -- usually more of a subjective feeling, very occasionally with minor objective signs.

The best way to find out what the effects will be for you is to take it. If the side effects are problematic, ask your doctor for another treatment option. If you are like 99.9% of people with this disorder, you will be considerably more functional with your disorder properly managed.
posted by LittleMissCranky at 4:59 AM on July 25, 2006

I'm on Lamictal. I have never had problems with fuzzy thinking on it at all. The only problem I have ever had with it is at first I had some mild headaches but now I have no side effects whatsoever. A few years ago they had me on Topamax, and THAT ruined my spelling totally. There's a reason they call it dopamax.n (Oh, and yes I am bipolar.)

The one big thing you have to watch on Lamictal is making sure you titrate on it slowly to help lessen the chances of you getting a rash. There's a rare syndrome that can kill you that starts with a rash but usually if you get a rash all you have to do is discontinue the medication and you will be fine.

Having said all that, to me Lamictal is a wonder drug. Be patient as it takes time for your dosage to build up, but in about a month you will be thrilled with it, I predict.

If you have any other questions I could help with, email's in my profile.
posted by konolia at 5:07 AM on July 25, 2006 [1 favorite]

The only negative side effect I know of is Stevens Johnson syndrome aka The Lamictal Rash. If you get it, you'll know immediately and call the doctor/go to the ER/discontinue use right away.

Lamictal plain didn't work with my seizures, but I had no major side effects. It seems to be a generally benign drug in my experience.
posted by wildeepdotorg at 5:08 AM on July 25, 2006

Oh, and I do need to say that untreated bipolar will eventually mess with your cognitive skills-also, a lot of people on bipolar forums are quite ill, have been in treatment with multiple meds for a long time, and so on. When I was sicker I hung out on the forums quite a bit-these days I don't go at all and never even really think of my illness except when I take my meds or am having a really bad day.
posted by konolia at 5:11 AM on July 25, 2006

Yeah, I agree with everyone above -- I am also taking Lamictal and I have been really really pleased with the stability it has given me, with no side effects that I can discern. (I didn't ever have a hint of the rash)... I am taking it alone (without an anti-depressant), and I can honestly say this is the best I've felt on any BP treatment. My day to day is much more positive, and the depressive side has pretty much disappeared -- my ADD has been helped a bit, but some of that in earlier years is/was likely undiagnosed BP disorder..

Also, I've been able to drop about 20 of the 50-60 pounds I gained over the years from lithium, tofranil, etc. I am continuing to lose weight with my diet and exercise changes.

All in all, great stuff, if a bit expensive, but really really happy with it. Give it a shot.
posted by wonderwisdom at 6:44 AM on July 25, 2006

I took it for almost a year and noticed no side effects at all. It really was light years ahead of the other meds I have taken. I had to discontinue it because I had no insurance and it is very expensive.
posted by RussHy at 6:47 AM on July 25, 2006

Some people get allergic responses to it, but if that's going to happen it will happen in the first week or two. The result is a full body rash, and in that case the drug should be discontinued immediately and never taken again (in order to avoid anaphylactic shock).
posted by Steven C. Den Beste at 6:52 AM on July 25, 2006

I'm on Lamictal with minimal initial side effects. At first, I had REALLY painful swollen glands in my neck and a fever, but that went away when I titrated more slowly (increasing by 12.5 mg instead of 25). No cognitive side effects whatsoever (as opposed to some anti-depressants that made me totally stoned).
posted by unknowncommand at 7:14 AM on July 25, 2006

Oh, and they will try to scare you with Stevens-Johnson syndrome (I like to call it "the death rash," much to the annoyance of my former therapist). If you feel like being nauseated, feel free to Google Image that crap. But seriously, the incidence is less than 1% in bipolar patients.
posted by unknowncommand at 7:17 AM on July 25, 2006

Just as an aside, erythema multiforme major (aka Stevens-Johnson) isn't just due to lamotrigine. Many of the common mood stabilizers/seizure medications, along with antibiotics, COX-2 inhibitors, sulfa drugs, cancers, and infections have all been associated with it. And the estimated odds of developing this reaction on lamotrigine is 1-10 in 10,000.
posted by drpynchon at 7:29 AM on July 25, 2006

I've been taking it for about 3 months now and I've had no problems with it. Before I started it, I was so afraid of the rash that it took me a couple of weeks to actually fill the prescription. Once I did fill it, I was so freaked out about the possibility of S-J Syndrome that I broke out in hives (this always happens to me when I am stressing) and then worried that I had "the rash" (it really was just hives).

I've experienced no cognitive side effects whatsoever. Unlike Dopamax, I don't have fuzzy thinking and it hasn't dulled me. Topamax, Wellbutrin and several others left me at a loss for words and really screwed with my short term memory. For instance, if I was in the car with someone, I'd have to ask the name of were we were going 3 or 4 times. I would just totally forget the name. Sometimes I forgot the words for common things like pharmacy or street, right in the middle of a sentence. Other times, I would forget what I was talking about, right in the middle of a sentence. Just "poof" and my entire train of thought was gone. It was a horrible experience. Nothing like that has happened with Lamictal. On Lamictal, I simply feel normal.

I did experience headaches when I first started and when my dose increased. They weren't debilitating and the pain level was on par with a sinus headache.

My only major complaint is that it is a bitter, bitter pill. Lamictal bumped Prednisone from the first place slot on my list of worst tasting medicines.

Finally, I'm sure your doctor gave you the coupon for the free starter pack, if not, ask him/her about it. It was really helpful to have the doses planned out for the entire month.
posted by necessitas at 7:46 AM on July 25, 2006

The lamictal is not going to make you stupid. The "fuzzier thinking" is reported by some patients, but it's actually kind of hard to tease out whether a given patient is just missing the faux-clarity of the manic phase.

I was on lamictal for about two weeks for epilepsy. It made me completely stupid. I had never heard it was a possible side effect so didn't make the connection at first, just kept wondering why the hell I could not think clearly or even remember non-intellectual things, like my martial arts forms. When I figured out that it had begun right after I started on the medication, I told my doc and he didn't believe me - thought along the lines of...
the side effects [are] nonexistent...
it's actually kind of hard to tease out ...
mild cognitive slowing... a subjective feeling...
Finally I convinced him I needed to switch to something else, and immediately after going off it, my brain started working again.

Which is all to say a)it's not just a myth or a dismissable claim of whiny patients and b)you're not going to not notice it happening. If it affects you that way, which as others have mentioned, is not true for everyone, you should switch to something else. Don't second guess yourself if you are truly noticing the symptom, but don't get paranoid before you even try it. Most neuro drugs have side effects, but different people are susceptible to different ones. Lamictal is used as an anti-convulsant, but apparently causes seizures in some people! So if it can have completely oppositional effects in different individuals, there's no reason to assume that any given side effect will affect you - for all you know, lamictal could make you smarter :).
posted by mdn at 7:51 AM on July 25, 2006

Another data point to follow mdn:

A bipolar friend of mine took Lamictal much of last summer, and appeared to experience what Necessitas notably didn't: "left me at a loss for words and really screwed with my short term memory ... I'd have to ask the name of were we were going 3 or 4 times. I would just totally forget the name. Sometimes I forgot the words for common things ... right in the middle of a sentence. Other times, I would forget what I was talking about ... Just "poof" and my entire train of thought was gone."

She was very frustrated by the fuzzy-headed feeling.

It seems that with these powerful medications, effects on different people can vary widely and unpredictably.
posted by Tubes at 8:17 AM on July 25, 2006

I take Lamictal and I have not noticed any cognitive side effects. I have not had any other negative side effects after the titration period. I work with language myself and this drug has been great for my career. My concentration is better, I can be mentally present and working much more often, and I have fewer conflicts with coworkers. My boss, my editor, and my customers have been pleased with my writing so far this year. As always, YMMV.
posted by crazycanuck at 8:57 AM on July 25, 2006

The chronic rash is one of the more common (though still relatively uncommon) and noticeable side-effects of Lamictal. But if you know what to look for and have a good psychiatrist, you'll easily be able to I.D. the rash before it gets serious and switch treatment to a friendlier drug.

At large doses (usually epileptic treatment level doses; = or > 500 mg., I think) the cognitive side effects of Lamictal can start showing up. These are real and measurable, not just subjective--they can take the form of "losing" the names of common objects or excessive distraction.

I should stress though, that these particular symptoms won't experienced by all or even most users. IANAD, and don't have the percentages for how many people get which side effects; I'm under the impression that the chances of a serious bad reaction are there, but relatively small.

Keep a journal for the first few weeks of use, and don't hesitate to call your psych guy if anything abnormal and negative (either physical or mental) shows up.
posted by Iridic at 9:05 AM on July 25, 2006

Funny you should ask. Here's what I wrote yesterday about my experience on Lamictal.

I have taken both Topamax and Risperdal -- both made me so stupid it scared me. Lamictal not so.

One thing that I have experienced, and still experience from time to time, is sleeplessness -- I think that is the only side-effect I have seen from it.

Listen. Do it. Give it three weeks -- you've been unproductively crazy for three week periods in the past, haven't you? Even if Lamictal is everything you hope it is not, the trial period is no longer (probably shorter!) than the time you have probably spent lying in bed wanting to die when your symptoms were bad. So what do you lose?

Try to have an open mind, try hard to not anticipate side-effects. Cause, you know, after the people in that lifeboat fished me out of the water, it sucked -- everybody stank so bad, and there was nothing to read. Right?
posted by Methylviolet at 9:20 AM on July 25, 2006

Lamictal was great for me (for mild epilepsy, specifically), until I got Stevens-Johnson over two months after I started taking it. I had a relatively mild case of what is a potentially fatal reaction. I had the rash, my throat closed up and my lips swelled up to about 2x normal, cracked and then bled for three days. Bleeding from the eyes (albeit in small quantities) was uncomfortable. I hate to be the one voice of doom in the room, but I'm living proof that it does happen, however infrequently. A previous poster was right in stating that Lamictal is one of many things that can cause SJ, but they put the warning on Lamictal for a reason. I wouldn't advised against taking it, but be more aware of the risks and warning signs and make sure you know how to reach your doctor. I wish I had done a better job with all of those things...
posted by Sinner at 10:48 AM on July 25, 2006

Some people get allergic responses to it, but if that's going to happen it will happen in the first week or two.

False, and irresponsibly so.
posted by ikkyu2 at 12:53 PM on July 25, 2006

Steven C. Den Beste: Some people get allergic responses to it, but if that's going to happen it will happen in the first week or two.

ikkyu2: False, and irresponsibly so.

You tell 'im. To quote myself: "Lamictal was great for me (for mild epilepsy, specifically), until I got Stevens-Johnson over two months after I started taking it."
posted by Sinner at 11:41 PM on July 25, 2006