Lamitrogine
We’re increasing it to 150mg/day, keeping the 1200mg of lithium and 150mg of Effexor XR the same, and I’m having my lithium levels checked. Hopefully, things will improve.
LAMICTAL (lamotrigine), an antiepileptic drug (AED) of the phenyltriazine class, is chemically unrelated to existing antiepileptic drugs. Its chemical name is 3,5-diamino-6-(2,3-dichlorophenyl)-as-triazine, its molecular formula is C9H7N5Cl2, and its molecular weight is 256.09. Lamotrigine is a white to pale cream-colored powder and has a pKa of 5.7. Lamotrigine is very slightly soluble in water (0.17 mg/mL at 25°C) and slightly soluble in 0.1 M HCl (4.1 mg/mL at 25° C).
INDICATIONS
…
Bipolar Disorder
LAMICTAL is indicated for the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy.
Structural formula of lamitrogine
The effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established.
The target dose of LAMICTAL is 200 mg/day. In the clinical trials, doses up to 400 mg/day as monotherapy were evaluated, however, no additional benefit was seen at 400 mg/day compared to 200 mg/day. Accordingly, doses above 200 mg/day are not recommended.
To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations of LAMICTAL should not be exceeded.
SERIOUS RASH REQUIRING HOSPITALIZATION AND DISCONTINUATION OF LAMICTAL, INCLUDING STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS, HAVE OCCURRED IN ASSOCIATION WITH THERAPY WITH LAMICTAL. RARE DEATHS HAVE BEEN REPORTED, BUT THEIR NUMBERS ARE TOO FEW TO PERMIT A PRECISE ESTIMATE OF THE RATE.
Adverse Events & Side Effects
Dream abnormalities occur in about 6% of lamitrogine users.
More common side effects include headache (25%), rash (11%), dizziness (10%), diarrhea (8%), dream abnormality (6%), and pruritus (6%). Events that occurred in 5% or more patients but equally or more frequently in the placebo group included: dizziness, mania, headache, infection, influenza, pain, accidental injury, diarrhea, and dyspepsia. Adverse events that occurred with a frequency of less than 5% and greater than 1% of patients receiving LAMICTAL and numerically more frequent than placebo included fever, neck pain, migraine, flatulence, weight gain, edema, arthralgia, myalgia, amnesia, depression, agitation, emotional lability, dyspraxia, abnormal thoughts, dream abnormality, hypoesthesia, sinusitis, and urinary frequency.
Adverse Events Following Abrupt Discontinuation
In the 2 maintenance trials, there was no increase in the incidence, severity or type of adverse events in Bipolar Disorder patients after abruptly terminating LAMICTAL therapy. In clinical trials in patients with Bipolar Disorder, 2 patients experienced seizures shortly after abrupt withdrawal of LAMICTAL. However, there were confounding factors that may have contributed to the occurrence of seizures in these bipolar patients.
Mania/Hypomania/Mixed Episodes
During the double-blind, placebo-controlled clinical trials in Bipolar I Disorder in which patients were converted to LAMICTAL monotherapy (100 to 400 mg/day) from other psychotropic medications and followed for durations up to 18 months, the rate of manic or hypomanic or mixed mood episodes reported as adverse experiences was 5% for patients treated with LAMICTAL (n = 227), 4% for patients treated with lithium (n = 166), and 7% for patients treated with placebo (n = 190). In all bipolar controlled trials combined, adverse events of mania (including hypomania and mixed mood episodes) were reported in 5% of patients treated with LAMICTAL (n = 956), 3% of patients treated with lithium (n = 280), and 4% of patients treated with placebo (n = 803).
Why Non-Cutters Should Worry Less: In Defense of Self-Mutilation, part four
How Much Should Cutting Worry Non-Cutters, as Opposed to, Say …
I don’t know. What are they worried about?
Cutting or any other act of self-mutilation is worrisome, of course, because it means that the person in question is not at peace with his/her world, that his/her emotional and psychological turmoil is not relieved by any socially acceptable means, and that s/he does not feel s/he can trust the coping skills endorsed by his/her parents, healthcare providers, teachers, etc., to take the place of self-harm. It means that the person probably feels a degree of lostness, loneliness, emptiness, sadness, anxiety, hatred, self-loathing, confusion, anger, and lots of other difficult emotions that may far surpass any negative emotion you have felt in your own life. It means that this person, in some sense, is exploring his/her own mortality and is, statistically, more likely to attempt suicide than a random person from the general population. If it were my friend of sibling or child, I would worry too, about the overall condition. (You should realize, of course, that freaking out, yelling at the person, imposing a Nazi-like set of rules, demanding sweeping changes right away, and/or inviting the person into a sweetly sanitized version of your world where everything will just be all right … These interventions are more likely to make things worse than better.)
But the cutting itself … What are you worried about?
Infection? That is a real concern, but it can be minimized with clean razors or knives, some rubbing alcohol or another antiseptic, and some gauze pads. When a cutter accepts the impulse to self-injure as a way of coping without burdening it with moral labels, the cutter will be more likely to do it safely.
Suicide? Cutting is not suicidal behavior, and does not necessarily indicate suicidal ideation. I sincerely doubt cutters are any more at risk for suicide than other depressed people with other less-than-ideal coping mechanisms like excessive drinking. Worry about the depression
Cutting as the New Teen Craze? No. There is a study published in summer 2007 claiming that 46% of teens have deliberately injured themselves (as opposed to 4% of the general population) and a 2008 Canadian study claiming 17.6% (or “one of six”) young people age 14 to 21 has done so. I suspect these studies are flawed and their numbers inflated, however. There is an enormous difference between generations in terms of what behavior would be reported in a psychological survey and how.
Teens today live in a more open culture in terms of psychological and psychiatric issues, and an arts and entertainment culture that often wears its pain on its sleeve (see emo). My guess is they are much more likely to report (and possibly more likely to overreport or falsely report) self-injury. Older cohorts, on the other hand, are less likely to admit to self-injury even on an anonymous survey—and this is increasingly true as we go back to older and older generations.
Categories of self-injury in these studies may be troublesome also. The articles linked above do not give sufficient detail to seriously examine this issue, but the numbers seem ridiculously high to me, so I find it suspicious. Behaviors listed in the articles include “cutting or burning skin, … biting or hitting oneself,” “scratching, … and minor overdoses of drugs (… prescription drugs [or] street drugs) and alcohol.” So every kid who pukes or passes out on drugs or booze is a self-injurer? Does hitting oneself include slapping oneself to stay awake? Does hitting or banging one’s head against a wall count (even though that probably would have been an expression of rage in older generations, not a deliberate self-injury)? Do injuries from Jackass-style pranks, backyard wrestling, or extreme sports count?
Don’t worry about the “fad”—the real fad is emo, which is essentially the same as that folk-singer-songwriter-confessional-poet-david-bowie-joy- division-robert-smith-morrissey-sad-grunge thing we all grew up on. It is no more dangerous now than it was then.
Cutting itself is not as dangerous as the hype suggests. I’d place it above habitual overeating, but below thrill-seeking extreme sports-type stuff on the danger scale. The risk is manageable. Like most addictions or habitual maladaptions, it will at some point cease to give the cutter what s/he wants, at which point a decision must be made, help must be sought (in my opinion), and recovery must begin.
Until then, friends and family of cutters, especially if you are non-cutters, need to focus on harm reduction and the underlying depression, anxiety, frustration, and/or stress lying under the self-injury. If you fuck this up by freaking out, moralizing, pontificating, accusing, etc., you will be much worse for the kid than the razor itself.
Related Posts on Other Blogs
Physiological Basis of Cutting: In Defense of Self-Mutilation, part two
Physiological Basis of Cutting
The easiest place to start is with the biochemical stuff. People understand that because it seems remote enough from the conscious choices we make. To the extent they have no choice, we don’t need to ask “Why do they do that?” Except, it’s not all that clear cut in this case. But it does provide a somewhat satisfying answer to the question, “What do they get out of it?”
They get endorphins coursing through their body, the body’s own natural opioid (kind of like heroin), which does a tremendous job (usually) alleviating pain and stress, lifting mood. Same stuff released during strenuous exercise and sex. It can help manage frustration, anxiety, depression, agitation, even some psychotic symptoms.
Like any short-circuit of the problem-resolution process coupled with an intense behavior-reward complex, cutting runs into the twin problems of limiting access to other coping skills and increasing dependence on (and addiction to) the rewarded behavior. Why spend months in intense therapy and struggling to change your behavior and interactions with the world so you can “feel better” when all you have to do is cut, and you know you’ll feel better immediately? And it does. It would not be this addictive if it were that effective in the first place.
… Next installment: Cultural/Evolutionary Basis of Cutting
In Defense of Self-Mutilation, part one
I hurt myself today
to see if I still feel
I focus on the pain
the only thing that’s real.
–Nine Inch Nails, “Hurt”
I wouldn’t say I’m pro-cutting, but neither am I anti-cutting. It is a coping mechanism with a significant short-term positive effect and fewer risks than some other coping mechanisms popular among people who don’t know how to cope. The Internet has a healthy population of sites and articles and posts that say much the same. My disagreement with these sites and articles and posts is that they usually lead and/or finish with “Stop Cutting!”
“Stop Cutting!” is as short-sighted a slogan, in its well-intentioned way, as “Just Say No!” was for drugs in the ’80s. (Reminds me of NWA, We don’t just say no, we’re too busy sayin’ yeah.) As a recovering alcoholic, I refuse to tell anyone else to “Stop Drinking!” regardless of quantities or destructive behaviors or deteriorating health. It wouldn’t do any good, and may backfire. After all, what the fuck do I know about someone else’s life? What makes me so much better than someone else that I can presume to tell him/her what to do? Defensiveness spikes and anger increases the urgency to get fucked up. Or, Increase the Stress >> Increase the Likelihood of the Maladaptive Coping Behavior. The truth is, an alcoholic generally is not going to stop drinking until s/he feels like it, “hits bottom,” makes a decision, etc. Even then, it’s far from easy. And, in my experience, cutting is very similar.
The biggest problem for the Anti-Cutting movement (and for anyone who deals with the issue in any way) is the biggest obstacle in the way of cutters who otherwise might be ready to put down the knives and razors. When cutting comes into a conversation, the response I hear most often from noncutters is “You know, I just don’t get the whole cutting thing, never have.” It aggravates me a little every time, probably just because it makes such sense to me, and there was always something very satisfying about cutting. It worked. For a while. But it’s difficult to explain to people who haven’t experienced it, haven’t needed it. Below is my attempt.
(First, let me kick my credentials: I first cut myself at age 18 with a big serated knife in my parents’ kitchen. I don’t recall hearing about people doing that sort of thing back then, except maybe once or twice among more sophisticated city folk, and then in the context of art or performance. It was years before the current cutting “epidemic.” I continued cutting, though not as frequently as some other cutters, until I stopped drinking and drugs about 5 years ago. The last time I obsessed about cutting and nearly picked up the knife again was about 2 months ago. Now, I’m on track to become a nurse practitioner working with children and adolescents with psych issues.)
… Next installment: Physiological Basis of Cutting
Related Posts on Other Blogs
pulling out hair gives tips to cutters and friends in “Self Injury Support”
Sun & Shield says Thou Shalt Not Cut in “A Biblical view on self-mutilation, or “cutting””
Teen Issues says, patronizingly, “Wanna join the new fad? Don’t.”
the kids speak in “Multigenre Fun” on writing lives/teaching lives
