So, without telling my life story, which I've subjected way too many people to: I was diagnosed with GAD/panic disorder in my early twenties and did well with SSRIs (taken off and on over the years), now the anxiety/agitation have gone out of control. I'm taking 75 mg of zoloft and considering going back to my low dose of paxil, gabapentin 600 mg at bedtime, ativan 1/2 mg twice a day and 1 mg at night. Even with all that, the anxiety and agitation are always there. I think I've developed a tolerance to the ativan but the psychiatrist doesn't want me to wean off right now because we're still adjusting other things. I can't take gabapentin during the day because it makes me dopey, then crabby.

Recently, the psychiatrist wrote for a start up dose of generic lamictal (25 mg every other day). I'd taken up to 100 mg/day before and didn't feel any difference at all. This time, every time I took it, I felt more restless and irritable. The second time I took it, I had terrible insomnia and spent the next day feeling like c***. I haven't officially been diagnosed with bipolar, but I have two close relatives with it and it's the only thing I can think of that would explain my sudden, terrible agitation with all the SSRI's and even a TCA. So now the psych. wants me to quit the lamictal and try trileptal which is supposed to be better for bipolar folks with lots of anxiety/agitation/irritability, which have definately been my defining characteristics for as long as I can remember.

So, my question is, has anyone been given lamictal for irritability only to have it get worse?

Anyone with these characteristics been on trileptal with good results? It's been almost a year now and I'm beginning to lose hope that I'll ever feel like myself again.

Thanks
Ali

Lamictal can be activating which can be helpful when lifting one out of a depressive episode. For some, it seems to not know when to "apply the breaks" which can cause irritability/nervousness. It helps me with depression but I too, get irritable when I take more than 100mg. To counter the irritability I must take zyprexa 5mg, although lithium is often used to work from the top down and help keep a lid on lamictals over-activation.
I had a brief stint on Trileptal last summer, the results were not great! I quickly sank into a very deep depression and stopped after 2 weeks. I believe it should be used only if one clearly presents with mania. JMHO.

Thanks for your response. I've had mild bouts of depression or just feeling sad for as long as I can remember, but the irritability and anxiety are by far my biggest problems, the most bothersome for me and my family. I hope the trileptal can take the edge off of that.

Ali

Lamictal was the only med that has been able to keep me stable with hardly any side effects. Please let us know how you are doing with trileptal if you do end up taking it. I'm curious as I have not tried that one myself.

I just started Trileptal on October 30th. I'm taking 300 mg a day(will increase to 600 in two days), along with 20 mg of Celexa(to increase to 40mg in two days). I am also weaning off Klonopin right now. I have been anxious since I've started these medications. Although it could be because I'm weaning off the Klonopin. Mainly, I bite my lip and grind my teeth so bad that my jaw hurts. I'd be interested if the Trileptal helps with anxiety, too. My Pdoc did say the Celexa should help. :-/ Sorry I couldn't offer any help, I'm just curious, myself.

I had issues with insomnia and irritability while I was taking an SSRI with Lamictal. It was also making me very anxious and agitated. Once my shrink got me off of the SSRI and increased to Lamictal dose, everything was much better. Lamictal does male me irritable, but it's managable; I haven't had any external issues with it.

Boy, I sure hope I don't have any anxiety issues with trileptal. that's the LAST thing I need. The whole reason the psychiatrist switched me to trileptal from lamictal is because he said lamictal has good antidepressant properties (meaning it will be more activating. Trileptal is supposed to be better for anxiety/irritability and it's supposed to make me sleepy, which would be great because I'm hoping to get off my ativan and take neurontin only as needed. I can't really take any of the AP's (the one I took was seroquel. It was a tiny dose that was supposed to help me sleep, but I got so restless I couldn't sleep and I woke up early feeling like I had fireants crawling all over me. I had bursts of panic all day and it took two days to wear off.)

I'm working in the direction of getting off the zoloft and maybe going back on paxil if I continue to have problems after trying the trileptal. It seemed to be the easiest on my system, although I couldn't afford to miss doses ever again! I've wondered lately if the reason I didn't do well on the lamictal this time is because I was at a higher dose of the SSRI and the two together were WAY too activating for me. I'm already a hyperactive stress-puppy (at least I was hyperactive until the exhaustion set in).

XF, IMHO, your doctor seems to be changing things extremely fast. My psychiatrist won't change more than one thing at a time (much to my chagrin, but it makes sense). He also told me to stay at the same dose on my ativan, even though I really want to wean off.

Well, let me know how things are going and I'll keep you posted.

Ali

I don't know why docs take people off of multiple medications at once...I have a BP friend who's currently being weaned off of 3 meds at once.. What a nightmare.

That seems like it would really do crazy things to your mind and body! It took me months before I found a med regimen that I could function on. I had to take the bedtime neurontin two hours apart, the ativan just as I was going to bed and as soon as I got up, etc. I had always told people I couldn't remember to take medications more than once a day if my life depended on it. Well, it does, and I do!

Adding one new med is so nerve wracking for me. I'm going to the nurse practitioner's today to pick up the script for the trileptal but won't be able to fill it until tomorrow. Now I have to decide what to do with the neurontin at bedtime!! Knowing myself like I do, I'll probably stand and stare at the pill bottle for half an hour trying to make myself take it.

Ali

I titrated up to 300mg of Lamictal taking 150mg morning and 150mg at night. I have terrible sleep patterns and Lamictal kept me awake. The PNP changed it to 300mg in the morning and with the other psych med I was able to sleep all night. It doesn't make me anxious or irritable.

I'm currently taking 800mg three times a day of Neurontin as an additional mood stabilizer and the tremors assoiciated with Parkinsonism. I wanted to take the total dose (2400mg) in the morning but I was informed that the life span of Neurontin is about 6 hours. A few years back, the FDA determined Neurontin didn't affect mental illnesses and removed the statement that it was good for mental health. Some pdocs continue to prescribe it for their patients.

Benzos are the common pmeds used for anxiety. If you haven't tried Klonopin, you might ask your pdoc about it. It made me sleep 22 hours a day and was taken off it.

I've never taken Triliptal and can't say much about it. You might want to Google it for more information. Since we all respond/react differently to meds, taking it may or may not help you. It's also common practice to change one med at a time to see if it works for you. Changing multiple meds at a time makes it difficult for the pdoc to determine which one is working.
Sheepwoman

I was really taken aback when I felt even more restless after I started back on the lamictal at 25 mg every other day since, when I was on 100 mg, I didn't feel a thing, it was like taking a sugar pill. When I talked to the psychiatrist on Monday I told him that the depression doesn't bother me nearly as much as the agitation and irritability, that's why he suggested the trileptal. Today, I'm feeling depressed because of some discussions I had with my counselor, then my new nurse practitioner, then my husband. I feel like a failure because I've been struggling with this for a year and I can't figure out what's wrong with me. My husband finally admitted that my being up and down all the time is affecting our relationship and our kids--that was just what I needed to hear.

I did try klonopin once at the recommendation of my primary doc but it also wore off in the middle of the night and I woke up in a panic. I tried a couple of times to take it during the day but it made me really groggy, which made me more irritable. I went back to ativan because it didn't make me sleepy so I could keep working. I take neurontin at bedtime for insomnia and to help mellow me out in the evening (I used to take 300 mg at six p.m. and another 300 mg just as I was going to bed). Recently, I started trying to take only 300 mg because the nurse practitioner said it could make parkinsonian symptoms worse if I take it with my SSRI??! Unfortunately, I can't take it during the day for the same reason I can't take klonopin during the day and even when I take neurontin right at bedtime, it still wears off in the middle of the night and I wake up early writhing in the bed (I always thought it was the ativan wearing off, now I'm not so sure). I would agree that neurontin isn't the greatest mood stabilizer used by itself. When I was still trying to take it in the morning I noticed that sometimes it made me drowsy, sometimes I felt drunk and disinhibited, sometimes it didn't seem to do anything at all, but when it started to wear off, I ALWAYS felt irritable.

Sheepwoman, is the parkinsonism because of other meds that you are taking? What kind of symptoms do you have with that or is it just hand tremors? I started having spasms of my eyelids last year when I was only on paxil and emotionally I got more and more irritable until finally, I had something of a meltdown. The psychiatrist thought it was my anxiety disorder and tried to increase the paxil which made me so anxious and restless that I could only describe it as akathisia. Since then I've been taken off paxil, switched to cymbalta, switched to lexapro, now on zoloft. Even when I take the zoloft in the morning, I wake up in the morning writhing with my head twitching. I feel tense nearly all day whether I feel "anxious" or not. My head twitches, especially in certain positions, and my eyebrow and eyelid muscles have taken on a life of their own. The psychiatrist says he doesn't think it is akathisia or parkinsonism (sp?) because I'm not on an AP (I tried a small dose of seroquel once and it made me a thousand times worse). He says it's extremely rare to get this from an SSRI. He also doesn't seem to think I'm bipolar but MAYBE some mood disorder NOS on top of anxiety disorder and panic.

So, do you take the neurontin every six hours during the day?

Thank you guys for your help.

Ali

Well, here's the sorry update on my Trileptal. I've managed to get up to 300 mg at night and I sleep pretty well but still wake up restless in the morning and I have to get out of bed. I'm down to 50 mg zoloft, which I take in the morning. I kept hoping the a.m. restlessness would go away if I took the zoloft in the morning, but no such luck, and a couple hours after I take the zoloft, my head starts twitching. I feel depressed all morning and start feeling anxious and tense with heart pounding and racing by about one in the afternoon. Sometimes my afternoon dose of ativan helps and sometimes it doesn't. I don't know if it's because the trileptal dose isn't high enough, if it's not the right medication, or if bipolar isn't even the right diagnosis. My primary doc told me she thought I should go down to 25 mg of zoloft until I can see the new psych NP because it's possible that the zoloft is causing rapid cycling. I guess maybe it would be a good thing just to get off it altogether and start over with the new guy.

xf89, how are you doing on your trileptal?

Ali,

Could you split your trileptal dose between the morning and the evening?

I suppose I could try again now that I've been on 300 mg at night, but the last time I tried to take 150 during the day I was so sedated I couldn't function at all. It almost seems like it would be easier for me to take gabapentin three times a day. I guess it just feels like the trileptal is a lot more potent. That's why I was wondering how abilify works and maybe if it's not as sedating.

I don't know much about Abilify, I have had family take it in conjunction with ADs when the ADs pooped out and had success. But I have a BP friend who took it and it caused her a lot of anxiety.. I would try taking the Neurontin 3 times a day; I know it's sedating, but it's what I do. It does make it kind of hard to function, but I'm a teacher and I manage. Heck, I worked a 13 hour day yesterday between my two jobs and it worked out alright.

Yikes, that sounds pretty stressful. I had kind of a long day with my appointment right after work. It was dark by the time I got home.

It's a funny thing with the neurontin, I kept thinking the groggies would wear off over time and sometimes I would take it and feel just a little fuzzy and sometimes I would feel nothing, but other times I felt like I'd just had a very large beer (and I don't drink because I'm such a light weight). Many times, when I tried taking it in the morning, I didn't actually get groggy until about four hours later, which, according to the half life, would be about the time it starts wearing off. I wonder if the new brand name one does the same--Lyrica. My mother keeps telling me I should try that. I wonder if it's longer acting? I keep feeling like if I could find something to "buffer" my nervous system like the neurontin, but more consistently, I wouldn't be so irritable all the time.