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Triathlete switching from Keppra & Effexor to lamotrigine


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#1 In_Remission_addinde

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Posted 26 October 2010 - 06:12 PM

So this is my first post. I just got prescribed Lamictal (got the generic Teva brand). My hope is that this med will finally help fill the slot of mood stabilizer / seizure med. I have been riding the mood medication merry go round (zoloft, prozac, paxil, welbutrin, lexapro,lithium, cymbalta, abilify, and now Effexor XR) for about ten years since my first seizure and anxiety/depression kicked in. I have just been diagnosed as BP II, and am confident that I am finally heading in the right direction after years of (sometimes daily) mood cycling. After doing research on my own, I decided to man up and TELL my psych that the SSRI/SNRI route just was not cutting it and that I would like to try drop my Keppra and try Lamictal as a mood stabilizer as wel as primary seizure med. For the past few months I have been on Keppra for my partial complex seizures and it made me into a miserable SOB by sending me into a dark pit of depression.

I also take Adderall XR for my severe add, and it has been a miracle drug for me, as well as Coumadin for a genetic blood clotting disorder.

My question is almost as complex as my history. I hate the fact that I have to take these meds, but have finally come to the realization that I am going to need them for the rest of my life. I am a competitive triathlete, and through most of the year I am very active and eat well. It is only when I start cycling and the depression kicks in that I become a junk food eating couch potato for days, weeks or even months. I am currently experiencing one of my depressive phases.

1)Can anyone give me an idea what to expect as I start taking Lamictal with the Adderall and Effexor? My psych wants me to titrate the Effexor down slowly to about 75 mg pd as I titrate the Lamictal slowly up towards 200mg. I am starting at 25 mg pd.

2)Does anyone have experience doing long amounts of exercise on this med? I dont have any races for the next few months, but I do race in Ironman distance triathlons, and don't want to take something that is going to kill my performance. My current regimen has really hurt my performance this year, and I want to try and fix the problem, not make it worse.

Any input would be appreciated.





#2 Jerod Poore

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Posted 30 October 2010 - 03:23 PM

I've changed the title of this topic to something relevant.

try drop my Keppra and try Lamictal as a mood stabilizer as wel as primary seizure med. For the past few months I have been on Keppra for my partial complex seizures and it made me into a miserable SOB by sending me into a dark pit of depression.


Keppra and Lamictal have really different mechanisms of action, and Keppra has hardly any drug-drug interactions, and that includes Coumadin (warfarin) - the drug that every pharmaceutical company is scared shitless over interactions with. So just in case the Lamictal doesn't work for the seizures, have you tried taking Keppra three times a day? With its really short half-life (6-8 hours), twice-a-day dosing doesn't maintain a true steady state, and that's what seems to cause the infamous Keppra depression and/or anger for some people.

1)Can anyone give me an idea what to expect as I start taking Lamictal with the Adderall and Effexor? My psych wants me to titrate the Effexor down slowly to about 75 mg pd as I titrate the Lamictal slowly up towards 200mg. I am starting at 25 mg pd.


That depends on your Lamictal titration schedule, the cross-tapering of Keppra, and how well you deal with Effexor discontinuation. If you define "slowly" as a week, there shouldn't be much of a problem as far the Effexor discontinuation is concerned. Effexor + low dosage Lamictal + Adderall could equal mania if you're not taking any Keppra. And if you're not taking Keppra and the Lamictal dosage is too low the Adderall would probably do wonders for your seizure threshold.

When taking Lamictal, and no other anticonvulsant, for both bipolar disorder and epilepsy, you don't have the luxury of stopping at the dosage that works for mood stabilization.

2)Does anyone have experience doing long amounts of exercise on this med? I dont have any races for the next few months, but I do race in Ironman distance triathlons, and don't want to take something that is going to kill my performance. My current regimen has really hurt my performance this year, and I want to try and fix the problem, not make it worse.


I have no experience with long exercise on meds, and nothing close to what you do under any circumstances. The only thing I can find in the literature is an increased risk of hyponatremia, which happens to people taking anticonvulsants who sit around all day watching TV. So you'll need to increase the electrolyte content of your drinks. Other than that, you're in a much better position to tell us if the severe muscle ache side effect from Lamictal and/or a full-on tonic-clonic seizure, if you have the misfortune to experience either, really does feel like the aftermath of a triathlon.
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I am not a doctor, nor do I play one on TV. No doctor, nurse, pharmacist or lawyer was harmed in the creation of this post. No warranty is expressed or implied. Not valid with any other offer. Void where prohibited.

Current meds: lamotrigine 200mg, topiramate 400mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, lorazepam 1mg PRN
Past meds (likely incomplete): Abilify, clonazepam, desipramine, diazepam, Gabitril, lithium, methylphenidate, Neurontin, Paxil, prochlorperazine, Provigil, Prozac, Risperdal, Seroquel, Serzone, Strattera, Trileptal, Zyprexa


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