Q:  How Does a Person Feel When Taking Too Much Lamictal?

Hi Dr Phelps ,

First I wanted to thank you so much your website psycheducation.org -  without that website my parents would still probably have no idea what bipolar disorder is - the first thing that really got their attn was the article about the man who had 48 Hour Rapid Cyling Bipolar Disorder.

The other article that really helped my parents to begin to understand was the one titled :  "Rapid Cycling + Mixed States as Waves" that article really hit home for me as well.

I've had bipolar disorder for over 8 yrs + had tried everything to connect w/ my parents trying to explain the disease to them - your website was the breakthrough in our communication.

I'm on 150 mg Lamictal , 10 mg Serax , 0.5 mg Klonopin Wafers , 300 mg Litobid , 75 mcg Levoxyl (for Hashimoto's) , 50 mg Adderall.

I had gotten to taper down from 600 mg of Lithobid to 300 mg after the Lamictal had been on board for about 6 mos. 

It helped a lot in terms of mild congnitive impairment , I had a lot more enthusiasm + a little more energy.

After 9 mos on Lamictal I began to experience word finding difficulty. My dr gave me Cerefolin NAC - I guess Lamictal lowers the amt of folate in the brain? Something like that.

Anyway, after 3 wks it was like I had a new brain - my memory - I was so surprised at the info I could remember off the top of my head w/ out even trying + I remember the look on my bosses face - we were probably equally surprised. It was a great feeling.

(I work at the Chicago Board of Trade as a clerk // Broker's Asst. + have to be on my toes at all times)

That lasted for like 3 - 4 mos (this feeling of having my brain back like it was before I ever got sick). I was also very very happy at the time , maybe that also helped my brain.

I'm completely stable. But this mild cognitive impairment + my memories + emotions just don't match up right - my emotions are just kind of not enough to make me thrive in life.

I'll never stop taking Lithobid 300 mg as Lithium is the best antisuicide drug.

Do you know anything about how people feel when they are on "too much" Lamictal ? It seems like the rash is pretty much the only indicator of a dose being too high. 

Have been unable to find any info on this      - this question of "too much" Lamictal.

Cerefolin NAC should be given to everyone. Especially people on Lamictal. It's a horrible feeling that you are "brain damaged" from bipolar disorder and or the medications. I've accepted how the disease + the meds have changed my  mind.

But it's been one interesting experience - I plan to someday become a psychopharmacologist. It's my passion.

Please excuse my very long question. Thank you for your time + all of your passion you have put into sharing information w/ others. We need many more people like you - psycheducation is the key to help the consumer, the consumer's family + loved ones, and the medical professionals.

Hope you are having a great summer. Thank you again for your important work.

Emily
 

Dear Emily --

Thank you for the comments, and the encouragement. You ask: what does it feel like when people are on too much Lamictal? Just to assure you that I am not making this up, I will quote a reply I wrote for another visitor this week: "mild cognitive impairment: people have more difficulty remembering words, remembering peoples names, and they just don't feel quite mentally sharp. This diminishes as the dose is reduced and with only one or two exceptions, I have not seen it at a dose of 200 mg or less.".

In other words, I generally do not see limiting side effects, including any cognitive impact, at doses like you are taking -- even though this is a recognized side effect at higher doses. However, that said, it could be that you are somehow getting a fairly high blood level of lamotrigine (Lamictal). You could talk with your psychiatrist about very cautiously turning that down.

Meanwhile, I appreciate your insight regarding Cerefolin NAC. Here is the package insert, for the curious, always a good place to start when you run into a new medication. 

As you know, the medication contains not only folate but also Vitamin B12 (cobalamin), and N-acetylcysteine. Since you can easily get vitamin B12 from your diet (even vegetarians), the only other thing you are really getting from this pill, besides folate, is the N-acetylcysteine (only about 1% of dietary -- or pill form -- B12 is absorbed, so getting it from your diet is really much more efficient).  

How much value does N-acetylcysteine have? This looks like an open question, to my eye.   In a brief literature search, I see dead just last year there was a primary care doctor reporting six cases of memory improvement using N-acetylcysteine (McCaddon). But no big research trials. 

Conclusion: not sure if this particular formulation, the Cerofolin NAC, has any more value than generic folate, which I will bet is much cheaper (I didn't do that homework). Nevertheless, I might try getting folate to my patients on lamotrigine, as it has been retained to recommend folate for patients contemplating pregnancy taking other mood stabilizers. Thank you for the idea. (If it didn't work, I might try then switching to Cerofolin NAC to see if I could spot any difference.  This is not a very reliable research approach, as there are always so many other variables going on, but it can begin to generate an impression after a while of trying it).

Dr. Phelps