After a lot of research, I finally 'believe' my bp diagnosis. I am most definitely an ultra rapid cycler - sometimes moods change multiple times a day ranging from suicidal depression to elation, or hypomania to extreme agitation...I think I used to have longer periods of depression and either hypomania or mania when I was younger and that things have sped up exponentially (but I honestly can't be sure I'm remembering correctly...)

Anyway, for the first time in a long time I am desperate enough to escape this rollercoaster (I'm about to fail this quarter, which, if you knew me, is crazy and shocking). My doctors are pushing lamictal really hard - and honestly it sounds like a great drug, EXCEPT the skin rash thing, which frankly terrifies me to the point I can't bring myself to pop a pill (I have a prescription). I have terrible health anxiety, so it's just not going to happen...

The problem is I don't see any real alternatives (esp. meds used more for treating the depressive symptoms, since I don't think I have full-blown mania).

Anybody out there with rapid cycling whose had success with something?

[Nammu]

I stated the lamictal 3 1/2 weeks ago, they started me on the lowest starter pack. So I'm only up to 25mg everyday and week 5 I go up to 50mg. Still always to go, it is starting to help already and I've have Zero side effects.

The Pdoc also started me on Latuda at the same time also a low dose, I take it at dinner time and have had no side effects from this either. This is a first for me.

After my nightmare past experience with psych drugs I swore off all of them. But then everything I had to keep me going and stable fell apart and I too was desperate enough to try anything. Its been good so far the irritability and rage are down. The only drawback is they still dont help my not sleeping. I just got ambian for that, so so.

[Jim62]

I am an ultra rapid cycler too. In the course of a day I go from feeling normal to hypomania, to mania then finally into depression.

I take 400 mg of lamictal per day with no side effects. You only get the lamictal rash if you start at too high of a dose, so, they usually start you low and slow. Without the lamictal I was cycling two to three times per week. Now i cycle maybe two to three times per month.

Lamictal is a good drug. Dont let the rash scare you, it affects a very small number of people.

[crazycatlady_83]

I take Lamictal, and started with the starter pack also. It is true that the rashes can occur when starting at too high a dose, and also if you stop for more than 3 days you have to start all over again at the lower dose and work your way up. After 3 years on it, it felt like it was making me manic, so I've recently decreased from 300mg to 100mg. But I've never had any problems before that, and I tend to be more manic than depressed a majority of the time. I also take Geodon twice a day, and was taking that by itself for about a year with little problems. It brought me so down from the chance of mania that I had a flat personality, if that makes sense to you. But I lost all my baby weight on it and then some.

ugh, lamictal is so tempting! what freaks me out about the rash though (even if on a low low dose it's probably 1 in a million) is that once it starts - if it's SJS - there's nothing you can do about it but brace yourself and hope for the best...in other words, once you have it even stopping the medication won't necessarily stop it from progressing...that lack of control is terrifying to me. Sounds like you're all out of the 'danger zone' with it already - I envy you!

Anyone ever try topamax? I get migraines also, so it's rather appealing, but doesn't seem to be prescribed that often...

[Nammu]

The topamax did nothing for me. I too have migraines but it didn't help much with that either, the best migraine medicine is Frova. Unfortunately my insurance quit paying for it.

[r010159]

Originally Posted by thepterodactyl

ugh, lamictal is so tempting! what freaks me out about the rash though (even if on a low low dose it's probably 1 in a million) is that once it starts - if it's SJS - there's nothing you can do about it but brace yourself and hope for the best...in other words, once you have it even stopping the medication won't necessarily stop it from progressing...that lack of control is terrifying to me. Sounds like you're all out of the 'danger zone' with it already - I envy you!

Where did you hear this? I have read that if caught early enough there should be no problem. That is why it is a good idea to report any rash to your doctor ASAP. And this is why many doctors discontinue the medication at the first signs of a rash. I have also read if titrated up slowly enough, there is something like a one out of 10,000 chance of getting the rash. My doctor tells me this has never happened in the history of his practice. He has been in practice for over 30 years. On one job, he has an active case load of hundreds of patients. Then there is his private practice.

Please do not let your expectation bias (irrational fears) interpret what you read about this drug. You would be unnecessarily limiting your options. Get the information directly from a professional, like you own doctor.

[Marshellette]

Depakote is the strongest med for rapid cycling.

[Ltsmom]

I have rapid cycle and I've been on lamictal for several years. It has done wonders. I never had skin rash problems. My mom is also on the drug but for seizures at a MUCH higher (8x) dosage and she had some skin problems but we both agree it is worth it. I don't think the rash issues are to much for the people taking the dosage recommended for bp.

Btw- congrats on taking the leap! It is soooo hard to really accept that YOU are bipolar. It took me years of thinking doctors were wrong but once I accepted it and started on medication my life has changed so much for the better. Now I think of managing my bp like a diabetic manages insulin.

[PlasticTigerAsylum]

I have been on Lamictal for about a year now and take 400mg at bedtime and really just don't know if it works that well, the 2 things I really do notice is that it makes me very sleepy and I don't have any mania, which I actually miss because it was the only time I was happy.

John

Originally Posted by r010159

Where did you hear this? I have read that if caught early enough there should be no problem. That is why it is a good idea to report any rash to your doctor ASAP. And this is why many doctors discontinue the medication at the first signs of a rash. I have also read if titrated up slowly enough, there is something like a one out of 10,000 chance of getting the rash. My doctor tells me this has never happened in the history of his practice. He has been in practice for over 30 years. On one job, he has an active case load of hundreds of patients. Then there is his private practice.

Please do not let your expectation bias (irrational fears) interpret what you read about this drug. You would be unnecessarily limiting your options. Get the information directly from a professional, like you own doctor.

It's true the slow titration significantly decreases risk (so does being post-adolescent), so it is about 1 in 10,000. To someone without health phobias it would seem to be worth the risk, but unfortunately that is not me. It is true that once you show signs of the rash - if it's SJS and not a much more common mild allergy - there is nothing you can do but let it run its course and treat the symptoms. Even if you stop the meds right away it's still going to do it's thing, which is unpredictable. I am definitely NOT trying to make a case against lamictal based on this - I realize I am being totally irrational - but the rash fear is reason enough for me to avoid it, only because it triggers major anxiety (when I took Zyrtec for the 1st time I did it the parking lot of an emergency room "just in case" - that gives you an idea!)

Perhaps if they tranquilize me with something first and then feed me the lamictal

I managed to schedule an app. next week with a difference psychiatrist who is rumored to be much more understanding and open-minded...hopefully she will have some ideas, but I really appreciate everyone's comments!

[Marshellette]

Originally Posted by PlasticTigerAsylum

I have been on Lamictal for about a year now and take 400mg at bedtime and really just don't know if it works that well, the 2 things I really do notice is that it makes me very sleepy and I don't have any mania, which I actually miss because it was the only time I was happy.

John

Can't have it both ways. Sick and happy. Not sick yet technically unhappy.

[r010159]

Originally Posted by thepterodactyl

It's true the slow titration significantly decreases risk (so does being post-adolescent), so it is about 1 in 10,000. To someone without health phobias it would seem to be worth the risk, but unfortunately that is not me. It is true that once you show signs of the rash - if it's SJS and not a much more common mild allergy - there is nothing you can do but let it run its course and treat the symptoms. Even if you stop the meds right away it's still going to do it's thing, which is unpredictable. I am definitely NOT trying to make a case against lamictal based on this - I realize I am being totally irrational - but the rash fear is reason enough for me to avoid it, only because it triggers major anxiety (when I took Zyrtec for the 1st time I did it the parking lot of an emergency room "just in case" - that gives you an idea!)

Perhaps if they tranquilize me with something first and then feed me the lamictal

I managed to schedule an app. next week with a difference psychiatrist who is rumored to be much more understanding and open-minded...hopefully she will have some ideas, but I really appreciate everyone's comments!

Then I think is a good idea to avoid some other medications that can cause SJS. This includes the following in particular: Anti-convulsant like Carbamazepine, Valproic acid, Lamotrigine, anti-inflammatory like Ibuprofen, antibiotics like Sulfonamides, Penicillins and so forth. All of the above meds have SJS listed as a possible complication.

I hope this helps!

Stevens Johnson Syndrome, Toxic Epidermal Necrolysis. SJS/TEN. DermNet NZ