Having Ugly Withdrawal Symptoms

Last week (Thursday) my doctor lowered my Cymbalta dose from 60 mg to 30 mg and she started me on Lamotrigine (Lamictal). We are slowly increasing the dosage of the Lamictal and I'm only taking 25 mg a day right now, so I don't think the Lamictal is affecting me yet. However, the withdrawal symptoms from the decrease in Cymbalta are ugly. I've experienced medication withdrawal before when switching antidepressants, so I'm familiar with the symptoms. I guess I'm just venting because I feel awful right now.

If you are having a really rough time of it, you could ask your pdoc if you can be RX'd 20 mg tablets and go down in increments of ten instead of thirty using the 30s and the 20s. [50, 40, etc.]
It will take a little longer, and you will have to pay for another script but would certainly ease the transition.

One other option that is sometimes done is a doctor will RX an SSRI [prozac, luvox, celexa, zoloft] to transition to from the SNRI and then you drop the dosage of the SSRI... This may be less expensive or may not matter, depending on what you have for medication coverage and may also be complicated for your particular situation.

SNRIs are notoriously difficult to discontinue for a lot of people- I would call your pdoc and ask about either of these options or what they may have as other suggestions.

I'm on 120 mg / day of Cymbalta (generic variety) I've heard it's a bear to get off. Not looking forward to it should it ever occur. My pdoc tried adding Lamictal. But I developed Lamictal rash after about 6 weeks. So I had to stop.

Thank you for the advice. I'm not sure about my medication insurance rules, so I will have to look into it. Do you happen to know how long SNRI withdrawal usually symptoms last?

Did you start Lamictal at a low dose and gradually increase it? I'm very nervous about getting the Lamictal rash. I really want this med to work for me.

Yes, as I recall I started at 20 mg. /day / week. Then increased by 20 mg. / day each week up to 100 mg per day(?) I can't recall exactly. But it was the standard slow increase. After about 6 weeks or so, I developed reddish, slightly raised patches of skin on my chest & redness on my forearms. I had never heard of Lamictal rash & my pdoc never mentioned it as a possible side-effect. I just went to see my GP because the rash looked odd. He sent me immediately to a dermatologist. The dermatologist prescribed some ointment to put on it & a mild antibiotic. It cleared up quickly & with no problem. Of course they took me off the Lamictal right away. Since I had not been on it that long, I was able to stop it completely right away.

My understanding is that if one is going to develop the rash it generally appears after 6 to 8 weeks of starting it. (Although it can develop later.) As long as it's caught early it can be cleared up with little difficulty. It's only when it is let go for an extended period of time that it can become serious. So just keep watch & don't hesitate to check with your doctor if you have a concern.

It's not terribly uncommon to get some sort of rash on lamictal.. The Rash, Stevens Johnson syndrome, is not actually very common. Also, while it can be pretty harmful, it can be reversed by stopping the med and the initial symptoms are noticeable. It doesn't put you down in 12 hours, but it is important to check in with a professional if you develop a rash. One of he ways to try to avoid developing a rash is to not start anything with new dyes or perfumes, lotions etc. Even switching to perfume and dye free detergent, etc may help though the jury's kind of out on that?

I got the SJS rash on Lamictal. It started over the Christmas break while I was visiting my parents, it was a raised, reddish purple rash that hurt like a burn. It started with small round patches that spread. I showed it to my mom and wondered if I should stop the Lamictal, but ended up staying on it for 2 days until I was home, and my pdoc was not available until after the New Year so I went to the ER. They said it was likely SJS but it hadn't spread too much so they told me to discontinue the Lamictal and if it spread any further, especially to the mucous membranes, come back right away. Luckily, when I discontinued the Lamictal, the patches healed and disappeared. I took photos of it and showed them to my psychiatrist and she agreed that it was SJS.

The interesting thing was, I had been on Lamictal for more than a year, and hadn't made a dose adjustment. I did start a brand new medication at that time, and the ER doc and my psychiatrist thought adding the new med caused a surge in the level of Lamictal.

Thank you for replying and for the helpful info. I'm definitely watching for signs of a rash.

Thank you, Josie. My pdoc told me to contact her right away if I saw signs of a rash. I hope I don't have to.

I thought I had SJS rash. I went to urgent care. The doctor there showed me a picture of SJS. There was no visual comparison between what I had and SJS. I have been on 300mg with no problem now. I understand some pdocs stop Lamictal at the first sign of any rash. Perhaps this is done for liability reasons, but it appears not to be difficult to distinguish between SJS and a benign rash, particularly by a MD. I understand that most rashes on Lamictal are benign.

Bob

That is good to know. I wonder how many people have been taken off Lamictal because they developed an unrelated rash at some point. I hardly ever get rashes, so I'm hopeful. I really want this med to work as a mood stabilizer for me. I did do a google image search for the Lamictal rash, so I have a good idea what to look for.