Lamictal DOES cause hand tremors

Just an update on my previous Lamictal posts.

Over the past year I have gently tapered down my Lamictal from 250mg daily to 125mg. On the recent 150 to 125mg drop I noticed that my hand tremors (which have been plaguing me ever since I started taking Lamictal) improved considerably. To the extent that I'm not even self-conscious in coffee shops anymore. And that's the other point - coffee. Right in the beginning whenever I mentioned the hand shakes to anybody remotely medically enlightened they urged me to come off caffeine. I did. However, since stopping weed, and its major energising factor for me, I've re-taken up coffee. In a big way! 7 strong filter coffees a day. Despite this - my hand tremors still decreased.

And just to really drive the nail home: I hit a patch of depression about a month ago and assuming that it was due to dropping from 150 Lamictal to 125, I went back onto 150. Guess what!!! The tremors started again! So I'm back down to 125 and .....  guess what.... they've stopped again.

As a very keen photographer you can't imagine how happy I am about this development. Shaky hands are probably the worst impediment a photographer can have.

So, to all  Big Pharma participants - including PDocs, GPs, chemists et al:

You can give me all the fckn stats you want claiming that tremor is not a side effect of Lamictal. In my case - you're speaking Bull Poo!!

Liver detox

I went for a liver function test about 2 weeks ago and found that my enzyme levels were slightly elevated. Which is a Big Mystery, as I don't drink alcohol, don't smoke, don't drug etc. etc. Which leaves one possible culprit - meds.

A quick Ogle on goOgle, revealed that, yes, people on Fluoxotine and people on Lamictal have BOTH reported enzyme elevation as a side effect. So I spoke to my cousin, who happens to be a Doctor, and he "prescribed" me a 10 day liver detox. I scanned it and stuck it below, but it didn't come out as legible as before. Any how, in a nutshell, here's the deal. LOADS and LOADS of water. LOADS and LOADS of freshly squeezed lemon. And a few raw vegetables, salads, nuts and fruit thrown in throughout the day.

I'm presently on day 3. When I first looked at this diet I thought I would be hungry, hungry all the time. Wrong! I've never felt so bloated in my life. Must be all the liquids. Other than that I'm feeling a bit weak, but OK.

So far... Apparently, by day 3, you likely to hit a "healing crisis" - chronic headaches, possible diahorrea and vomiting, and runny nose. Sheesh! But to compensate, after day 10 you're also supposed to feel better than you've ever felt. I'll let you know how it goes.

If it goes well I'm planning to do this thing every 6 months. These meds are clearly not good on the liver, and my cuz says it should be mandatory. And yes, I may also cut my Lamictal from 250mg to 200mg.

Yes, Lamictal does cause tremors

Here's the results of a poll I put up a month or 2 ago. OK, so my PDoc was very quick to point out that a sample group of 53 is very far from drawing any scientific conclusions. But you know what Mrs PDoc - I trust these grassroots surveys way more than the drug company organised ones.

From the day I started taking Lamictal (aka Lamactil, Lamictan) 2 years ago - the hand tremmors started. But PDoc said NO, this particular side effect was not documented for Lamictal. My question is this though - how long do adverse side effects take to filter into the little accompanying drug info leaflets? No brainer - as long as possible if the drug co.s have any thing to do with it.

Indeed the whole Fckn irony of the thing is that the only reason us BiPolars are prescribed Lamictal is because curing BiPolar is a side effect of this anti-epileptic drug that was only discovered by accident way after the fact. But positive side-effects obviously get to press much quicker.

Man, I was so worried about these hand shakes that I even went to see a Neurologist a few months ago, fearing that I may have early onset Parkinsons. She did the whole barrage of knee-tapping and elbow-tapping tests on me and I was cleared (thank the gods!) of Parkinson's. When I told her about the Lamictan, she grabbed out her drug book (she's not a psychiatrist after all) and said "No, hand tremors is not listed here as a side-effect of Lamictal". Back to square fckn One.

She eventually diagnosed my condition as Essential Familial Tremor , which does, I suppose, have some credence as my Dad and Uncle have slight hand tremors too (although in your 70s whaddya expect??)

She said my tremors were likely to worsen with age. What was really weird is that she said there did happen to be one medication I could take to reduce the hand shake and that was... wait for it.....Topamax! Yeah, another former anti-epileptic now also used as a mood stabiliser. I mean how coincidental is that, especially seen as my Pdoc had once considered Topamax for my bipolar.

So I went back to PDoc with my story and she said i could switch to Topamax if I wanted to to. Or maybe even mix it into the daily routine.

But in the end I decided to put up with the friggin handshakes. As the neurologist said: "they're certainly not life threatening in any way." And I THINK Lamactil is helping my BiPolar (although I'll probably never know for certain) so I'm not gonna meddle with it. Maybe one day if my own biz doesn't work out and I'm forced to get a job I'll have to go the Topamax route, because as things stand shake now, I wouldn't even get past the first interview.


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Coming Off Anti-Psychotics

Its already 4 months since I took my last Fluanxol. Flaunxol is an old style anti-psychotic from the 80s which I've been on since my last hospitalised psychosis over 10 years ago.

Let me tell you - it's the best thing I ever did. Here's the good and the bad I've experienced in the last 3 months:

GOOD

• A lot more energy
• Still get bad downs on some days, but bounce back very quickly
• Much more enthusiastic about everything
• Majorly more productive at work
• More physically active, spend more time outdoors
• Reduced appetite
• Hand tremor has improved slightly
  

BAD

• Quite a bit of insomnia (although this isn't all bad because previously I was over-sleeping by a big margin)
• Lose my temper more often
• Get more hypomanic spells with racing thoughts

On Balance - a HUGE improvement in my life.

OK, so I hit a fairly strong hypo session late last year, and people were saying; "Hey BPG, get back on yr anti-psychotics". I have absolutely no doubt that the removal of the Fluanxol facilitated this hypomania. But if it ever does get out of hand, I've got a WAYYY better solution:

Instead of re-introducing Fluanxol, I'll rather cut my Prozac by half. Prozac and Fluanxol work against each other - the one pushing you up, the other pushing you down. So it seems to me that if I'm getting a little too up, rather reduce the Prozac. The standard reaction of throwing more and more pills at new symptoms is not always the only solution.

Don't get me wrong - I will still ALWAYS have a supply of Fluanxol on hand, and the first signs of delusional thinking and I'll pop at least 4. But its been 10 years with no full-blown mania and thats why my P-Doc and I decided to try coming off the anti-psychotics.

WARNING: DO NOT COME OFF ANTI-PSYCHOTICS WITHOUT CONSULTING A PDOC.

Chemical Regime

Back to BiPolar.

The pills above are my daily intake. From left:

• 40 mg Prozac (actually a generic thereof)
• 250 mg Lamictal
• 0.25 mg Fluanxol
• Omega 3 fatty acids (not sure of mg. - if you need to know leave a comment and I'll look it up)
• Omega 6 Fatty acids (ditto)
• High Strength Multi Mineral and Vitamen

This regiment is about to change though, with the complete dissapearance of the anti-psychotic. I'm already down to 1 every 3 days and this week they end. I've been tapering off for 3 months now.

In June my psychiatrist finally gave my anti-psychotic cessation her blessing. This was after a heated argument with her where I pointed out that in the past 15 years I have only spent approx 3 weeks psychotic and the majority of the rest in deep depression (see here). I'd done a little chemistry research on my medications and gathered that all the anti-depressant type stuff seems to promote dopamine, and the anti-psychotics to put a lid on it. So they were working against each other.

I've been on Fluanxol now for 15 years, longer than any other medication. I also read that it has bad long-term side effects. So far the change in my regime has had several noticeable effects:

• I'm not sleeping well. Toss and turn and often wake up throughout the night.
  
• I have a new craving for sunlight. The last 5 years I've had a distinct aversion to direct sunlight. I read somewhere that Fluanxol has photo-sensitivity side effects, so this might explain it.
  
• I'm definitley feeling a little more edgy and anxious in social situations. This, I suppose, is compounded by the fact that I haven't socialised a lot since stopping drinking, and whilst I was certainly never an alcoholic, I drank quite heavily in social situations. (I stopped drinking, by the way, because my depressed state could no longer handle the hangovers)
• As an extension of the above point - I'm really missing a cold beer right now. For the past year i haven't missed alcohol once)
• One of Fluanxol's documented side effects is that it can cause "Pakinsonian type symptoms". This is what prompted my to ditch it in the first place. I thought my chronic hand tremor would stop after taking Fluanxol out of the equation. Well, it hasn't. Which leaves Lamictal (as I've long thought) the prime suspect.
  
• Generally I'm feeling a whole lot more positive and happy. For the past 6 weeks I've been running 4 times a week, weight training and putting in more hours work than before. I'm also getting loads of African sunshine and am now a zealous believer in the healing properties of sunlight.
  
• Yep, I feel like I've turned a big corner. A long-term corner, not one of those little daily "In-the-Pink" thingys.
  

I've got to admit that deep down I'm a little fearful of going out into the big wide world sans anti-psychotics. Feels kind of like having sex with a stranger without a condom. And there is a good reason for this feeling. The last time I took myself off Flaunxol it was only a matter of 4 months before I was screaming down really steep hills on my bicylce, weaving in and out of heavy traffic, with my hands out either side like a flying bird. Put my army helmet on (with a big white "Y" painted on the front), when I went to vote at the national referendum. Stood outside afterwards and screamed at the top of my voice "Good morning South Africa". Phoned into a live tv talk show on religion to say that God had spoken to me personally. (fortunately the tv manager didn't put me through). Drove my car through a patch of fog on the highway and pulled to the side thinking it was smoke from an explosion. Became convinced that the large blister I got on each hand from windsurfing that day on Easter Sunday were the stigmatic wounds on Christ's hands. By the time I phoned Mother Mary (my therapist's name was Mary) at 3am in the morning, it was only a matter of hours before emergency hospitalisation.*

So you can see why a little concern is probably a healthy thing. And I've also realised that there is a HUGE logical hole in my argument that I've only been psychotic 3 weeks in the last 15 years. MAYBE IT'S LIKE THAT PRECISELY BECAUSE I WAS ON THE MEDICATION.


*right now, I'm thinking that I must post more about this experience someday

Lamictal

A lot of people have been arriving at this blog via the Lamictal keyword. So I thought it might be a good idea to re-assess my Lamictal (known as Lamictan in my home spot, South Africa) experience. I've been on it for 1 year and 9 months now, and the last time I think I spoke about Lamactil was when I'd crossed the one year mark. So here goes:

(by the way: please be sure to participate in the Lamictal poll at the bottom of this page (after this post))

Easing Depression
The best thing about Lamictal is that it has definitely taken the sting out of the bad downs. I'm told that whereas other stabilisers are more effective at controlling the ups, Lamactil is better where the predominant pole is depression. In fact a danger with BiPolar (I'm told) is that Lamictal can sometimes fuel the highs. Truth be told, I hit about 2 weeks of severe mania about 6 months after starting the medication, with occasional small flights into psychosis. (Man, would I have loved to chronicle those in this blog but unfortunately it was pre BiPolar Daily). Having said that, it was one of the most controlled (and enjoyable :) mania's I've had - I didn't even tell the Pdoc about it.

All been said, I can certianly say that the depressions before going onto Lamictal were worse. At certain points in the past I had even rationalised suicide. (see here) Nowadays the depressions are still there, but they're more marked by energy slumps than that knife-churning desperation. And no matter how bleak you get, there seems to be an underlying contentment holding everything up.

The "Fizzle Out" Factor
With me I've definitely experienced a "fizzle out" factor with Lamictal . "Fizzle out" meaning that the positive effect seems to wear off over time. I'm not sure that this is just a Lamictan thing though. I've experienced the same on the 3 occassions when I've started Prozac after a non-prozac spell. You get this kind of surge of positive energy for the first few months and then gradualy things seem to taper back to normal. Maybe your body developes some type of chemical immunity. And I'm sure some of it is psychological. You just acclimatize to a more positive level and that becomes the norm. Maybe it's just the sudden change of the medication regime that jolts you out of complacency. "A change is as good as holiday". About 2 months ago I instituted another slight change and split my dose over night and day (200mg in the morning and 50 mg at night, as opposed to all in the morning). This also gave me a positive boost for a month.

Andre Solomom, in his bestselling book "The Noonday Demon" spoke about the fizzle out with medications. Personally I find this the most worrying factor with BiPolar. What if every medication you try eventually fizzles out?? A soul-crushing prospect.

Side Effects
Although I've scoured the Net, and spent many discussions with my Psychiatrist, it seems that I am the only one that suffers from chronic shakes. I've never had rock-solid steady hands, but since starting Lamictan, there has undoubtedly been an increase in my hand tremor. And it's BAD, believe me - I've even stopped going to coffee shops as I've been known to spill my cup and am very aware of everyone staring at me thinking "Shame, poor alcoholic". And I DON'T drink. I stopped over a year ago to avoid the excruciating "hangover depressions".

I've cut my caffeine down to 2 cups a day, but it doesn't seem to have helped. Admittedly I'm on other medication too - 0.25mg Fluaxol (an old-style anti-psychotic) and 40mg Prozac (you know what). I even cut back on the Fluanxol two months ago (after much persuasion to Pdoc) because some scouting on the Neb revealed some horrible side effects with Fluanxol, inculding involuntary motor tremors and a contra-indication with Parkinson's Disease. The point is though that I've been on Fluanxol nigh on 10 years and the side effect was never as bad as when I started Lamactil. (BTW: this occassional misspelling of Lamictal is intentional as I aim to snare all those searchers that type the word wrong on Goggle. And Lamactin for South Africans.) (sneaky, huh). Maybe it's just the rare concoction of my particular medication cocktail that is the culprit.

I'm told that I could start another medication (beta-blockers) to chill the shaking, but I've opted not too. Sheesh, I'm on enough concoctions. Start beta-blockers and next thing you need something to cool those side effects. And, as embarrasing as the shakes are, they don't have any other health detriments. As a full-time recluse I don't have that many chances to get embarassed anyway...

Actually, I'm seriously thinking now that I might have early onset Parkinson's Disease. My grandfather had it and I'm definitely lacking other explanations. I must drag myself off to a Parkinson's specialist. Yay, nothing like another chronic condition to deal with!

The Psychological Factor
Invariably people are put on Lamictal at the same time they are "officialy" diagnosed with BiPolar Disorder. So besides going on new medication there is another profound (but often unacknowledged) shift that happens: Acceptance that you have a chronic condition. True acceptance has an extremely cathartic effect. Certainly this was the story in my case. In fact I would say that the psychological paradigm adjustment that TOTAL acceptance bought with it, to both me and those around me, was the biggest help in my journey; way bigger than any pill could be. In fact so huge is the acceptance factor that it really deserves a post of it's own one day. Which means I must drag myself down to my office round about now, to coax my demeanour into work mode...

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Wonder drug

Now that all the rants are out the way...

Actually, I shouldn't be so harsh on psychiatrists. The Lamactin (Lamactil for you guys in the US) my current psychiatrist put me on last November has changed my life. I cannot believe how well I've been this month. (Note from psychiatrist - "not too well I hope")

(by the way: please be sure to participate in the Lamictal poll at the bottom of this page (after this post))

Maybe this is how spring is meant to be. Has meant to have been all along. If only I had taken my shit-tinted glasses off...

Don't get me wrong - I know there are plenty more downs awaiting me on my path. That is preordained in my DNA. (stick with this blog and you'll see what I mean). But the good periods are getting better and longer. If only I'd been put on this wonder drug 15 years ago...

When I think back to November 2 years ago: the engine was sputtering, finally stalled and BiPolar Guy ground down to a standstill. No hope. Desperation. A stifling black prison with no chance of parole. At the time I tried to pin it on my philosophy studies. The nihilism of Postmodernism. The existential angst of Sartre. Then I tried to pin it on my bleak financial outlook. I went through a marxist phase, decrying the cruelty of the Capitalist dog-eat-dog system. I even started doubting my relationship. Maybe she wasn't right for me. I mean shit, something's got to be wrong.

Sure there was something wrong: the chemicals in my brain. No Marxism, new girlfiend, or feel-good philosophy was ever going to heal that.

Enter Lamactin/Lamactil. BiPolar people - if you're on medication that is working for you - that is cool. But if you're still experimenting, flitting from one cocktail to the next, trying to pin your woes on the external world - TRY LAMACTIN. Sure it's not going to work for everyone. But take it from me - it's worth the try.

Lamactin Medication

The Lamactin medication (known as Lamactil in the US) I've been on since last November has definitely improved my life. I'll only know for sure though at the end of November - the first complete 12 month run. I say this because November has historically been my worst month as far as depression goes. (see here for reasons) . So the next 6 weeks will be the real acid test.

Lamactin is a very new mood stabiliser. It started out its career as a anti-convulsive for epilepsy sufferers. It can be pretty scary when you first take it, as in some cases it leads to bad rashes which, if untreated, can land up in fatal Stephens Johnson syndrome. So you've got to start on a really low dosage and build up from there (and hold your thumbs).

Luckily no rashes broke out on BiPolar Guy, so I've been on daily Lamactin ever since Nov 2004. The changes I've experienced:

• I've been waking earlier ever since. This could be a secondary effect though, as I've always woken early when not depressed.
• When I have "Got-a-Gun?" days (yip, I still get them) , the lows, although intense, are not as desperate as before. Deep down there is an unwavering bedrock of contentment.
• The lows don't last as long. Previously they could hit for weeks at a time whereas now the bad downs ("Got-a-Gun?" ones, not "Pretty Shitty" ones) seem only to be temporary dips.
• I've lost a fair amount of weight (which is a good thing). Once again this could be a secondary effect as "Got-a-Gun" eats 3 times as much as "In-the-Pink". Having said this though, it is a known fact that Lamactin puts on much less weight than Lithium and stuff like that.
• I've developed quite a bad tremor in my hands in the last year. And NO its definitely not from alcohol - I haven't had a drop this year. In fact its quite awkward when I go to coffee shops because the trembling coffee cups DO make you seem like an Alcoholic. Which is why I try and stick to coffee shops that serve in mugs as opposed to those dainty little cups with handles. (Actually, come to think of it, the 8 cups of strong coffee that I consume daily can't be good for the shakes either).

What else can I tell you about Lamactin? My psychiatrist says it's better at controlling BiPolar predominated by downs as opposed to ups. The great thing is that it is recognised as a chronic medication for BiPolar, so my medical aid covers it gratis.

Well, that's it for now. My last few posts have been wandering off topic a bit, something that the Almighty Search Engines penalise you for, so I thought I'd better rectify things a bit so that my rankings don't slip too far down the search results.

Fluoxotine and Fluanxol 2

What I was talking about yesterday:

Today:

Fluoxotine and Fluanxol

How's this for a quirk? I start my day with 3 medications:

• Fluanxol - to thwart "YeeHaaa!',
• Fluoxotine (alias Prozac) - to thwart "Got-a-Gun?",
• and Lamactin to try spend more time in "Halfway House"

So the Fluanxol and Fluoxotine are the upper and lower Guardians of extreme FLUX.

FLUanXol, FLUoXotine. Get it?

Or how about this one: In 1992 I wind up in a psychiatric ward convinced that I am the third Messiah ( the Second Messiah having arrived in 1984 when I was hospitalised the first time).

So they hospitalise me because I'm O.T.T. (Over the Top)

After a week when I am despatched in a drugged haze they give me T.T.O's (Tablet's to Take Out) (no, I'm not making this term up - this is regular hospital jargon).

And my best friend in the ward for the week was none other than Mr. OTTO!!