Nuvaring and lamictal

29f History: Hashimotos, high cholesterol, adhd, synovial chondromatosis, bipolar disorder, depression Medications: hydroxyzine, lamictal, Levothyroxine, atorvastatin, nuvaring, quetiapine, vyvanse on occasion Non medication: heavy weed use, light tobacco use
My urine tests come back regularly for blood cells in my urine and my doctor just keeps telling me to drink more water. I’ve told her multiple times water isn’t helping and no matter how much I drink, I pee every half an hour (sometimes more frequently, always a true pee, not just a feeling or a sprinkle)
My most recent tests look like there’s a problem with my kidneys but I don’t know if I’m just being a hypochondriac or if I should ask for additional testing/get a new doctor?
Test results below. Thanks https://ibb.co/5srTCYG https://ibb.co/cYZ4s89 https://ibb.co/WK86CVN https://ibb.co/92c9BKB https://ibb.co/Bjj8sND

I’ve been on Lamictal and Wellbutrin since Sept 2023. Both have massively helped my bipolar. I haven’t been on birth control for years, but got back on it recently. I was told by my GP that it could affect Lamictal levels but they assured me it was unlikely. Apparently hormonal BC can do this.
Fast forward and I am a MESS. I’ve been on my period for 2 weeks, my emotions are all over the place by the hour. I ended up stopping it tonight because I have been incredibly stable with my current meds up until the addition of NuvaRing.
Has anyone ever taken hormonal BC with Lamictal and what was your experience?
EDIT: A bit of background, I’ve had issues with the pill and Nexplanon before I was on meds. Physical, but still shitty. NuvaRing was the only method I could tolerate

Hi! Im going to try to put as much detail as possible because i know how important PMH is; im looking for advice/opinion.
Im 22f (east asian) with no history of STDs or pregnancy. Ive had 2 UTIs within my life that responded well to macrobid. My last UTI was 9/2023. I currently have one long term partner who has been STD tested and i regularly get tested anyways due to my own belief of "better safe than sorry", though i have no concern of infidelity. We do not use condoms and when i am not on my period, we have sex 4-7 times a week. I take a pregnancy test once every four weeks just to be sure I am not pregnant. Despite this, i still take a women's multivitamin with folic acid. I last tested myself 11/20 (negative result). I have mild hypertriglycerdemia (genetic, 180 mg/dL per last blood work) with all other values normal on my lipid panel, thyroid test, and metabolic panel. I am 5'2" 115lbs with no other diagnosed physical comorbidities. My mother was adopted and has a history of gestational diabetes, prediabetes, and hypertriglycerdemia. I have no information or knowledge of my biological fathers health history except for an undiagnosed mood disorder. No other history of health complications.
I am diagnosed with PMDD, major depressive disorder, general anxiety disorder, and adhd (inattentive type). I have an ongoing issue with tachycardia, most likely medication induced, but no hypertension. I am currently taking Vyvanse 50mg (qd prn), buspar 10mg (qam), lamictal 100mg (qam), effexor xr 225mg (qam), cetirizine 10mg (qam), trazodone 25mg (qhs prn), and YAZ (bc) (qd at 9pm). I do not take placebo doses of my birth control. I am very medication compliant.
Onto the more relevant medication change. Ive been on and off generic YAZ for the last 3.5 years, my last "on" period of time was between 6/1/23-8/1/23, once daily, skipping placebo pills. After an annual visit with a new OBGYN, I started using NuvaRing 8/1/23 and would replace it once every 3 weeks. However, after my first time using NuvaRing, i experienced an 8 day menstruation period with heavy-moderate bleeding. However, i was not concerned because I knew it was most likely due to my birth control change. In September, it increased to 10 days with moderate bleeding but i knew it would take a few months for my body to regulate my cycle. In october it increased to 14 days with moderate to light bleeding. During these three cycles, i would take out my ring on the first 3-5 days of my cycle and used a combination of tampons and a menstrual cup, cleaned with each use. I would reinsert my nuvaring after i noticed a decrease in bleeding, never more than five days after initial start of menstruation. I would reinsert it despite ongoing bleeding because of history of awful mood changes and passive suicidal ideation if i go too long without restarting my birth control. I would use a tampon with the nuvaring and also believed my increased length of cycle was due to the physical barrier of the ring. After i noticed progressively worse mood changes from the time of starting the nuvaring, i switched back to generic yaz as i only experienced mild mood changes when taking yaz. I made this switch 11/14/23. In november, my menstruation started 11/2/23 and is still ongoing (as of today, 11/25/23,) with light bleeding, mostly brown in color but about five days ago, 11/20/23, i noticed new red blood. Ive experienced a recent increase in nausea and fatigue within the last week. My breasts have also been more sensitive.
Im honestly just very worried that something is wrong. I have an appointment in two weeks but the continuous bleeding is scaring me because its not showing any signs of ending or decreasing in amount. Any advice would be helpful, thank you in advance!

I am a 30F, 5’9, Caucasian, diagnosed with Bipolar II and Idiopathic Hypersomnia. I take lamictal (200 mg), Xywav (4.5 2x nightly), and use a Nuvaring, I don’t smoke or use drugs, and I drink occasionally. I have been losing weight rapidly. I started at 140 in August of last year. I kept losing weight and by May I was starting to freak out so I went to my primary. She ran a lot of blood work and had a urine sample done. Nothing appeared off, in fact all my tests looked completely normal. She had me return in June to check my weight, which went down by another 4 pounds. I was referred to GI because I had a change in my bowl habits (3-5x a day) and they look funky. Some are a rust color, others are broken up, but never diarrhea. I found what I thought was a segment of a tape worm in my stool about 2 weeks ago. It was 4 inches long, white, thin, and looked kind of flat. I ended up taking 3 doses of praziquantel. I ended up getting better, but now I’m feeling even worse. Recently, as in the last week I’m dropping a pound a day. I’m at 119 pounds. I have a lack of appetite, stomach cramps, abdominal pressure by my bladder, and nausea and dry heaves every morning, which lasts till mid afternoon. When I visited the GI yesterday they recommended a colonoscopy and endoscopy, which is scheduled in mid-October. I also had a CT Scan last weekend when I went to urgent care because I thought I had another UTI, I had one this summer and they were concerned it never cleared. CT looked normal. I thought I had a UTI because of the pressure near my bladder and I have trouble getting started. I’m scared and worried that I’m going to die from being too thin. How much weight do I need to lose to get help? What should I do? I’m at a loss and ironically in one of the more densely populated areas in the US with “world class medical care.”

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19F, 5'9 156 pounds, mixed race black and white, antibiotic resistance maybe? and sleep issues, don't use any recreational drugs
Patient Active Problem List
Diagnosis Anxiety Bilateral temporomandibular joint pain Cognitive disorder Disorder of peripheral autonomic nervous system Iron deficiency anemia Irritable bowel syndrome with diarrhea Severe episode of recurrent major depressive disorder, without psychotic features POTS (postural orthostatic tachycardia syndrome) Death of parent Circadian rhythm sleep disorder Dysphagia Psychophysiological insomnia Migraine aura, persistent PTSD (post-traumatic stress disorder)
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Current Outpatient Medications on File Prior to Visit >! Medication Sig Dispense Refill celecoxib (CELEBREX) 400 MG capsule Take 400 mg by mouth Daily. etonogestrel-ethinyl estradiol (NUVARING) 0.12-0.015 MG/24HR vaginal ring Place 1 each vaginally. lamoTRIgine (LAMICTAL) 150 MG tablet Take 150 mg by mouth Daily. midodrine (PROAMATINE) 10 MG tablet Take 10 mg by mouth 3 times daily. pyridostigmine (MESTINON) 60 mg tablet Take 60 mg by mouth 2 times daily. topiramate (TOPAMAX) 50 MG tablet Take 3 tablets by mouth 2 times daily. traZODone (DESYREL) 50 mg tablet take 1 AND 1/2 tablets by mouth once daily AT NIGHT (Patient taking differently: 100 mg.) 45 tablet 0 !<
I've been on lower doses of some pretty intense antibiotics or drugs like Azithromycin, Cefdinir, invermectin, to treat chronic Lyme disease for a couple of years. I recently realized it doesn't exist (or at least is highly misleading, post treatment Lyme exists but is very different than what chronic Lyme is) and came off the antibiotics and other Lyme related drugs in February I think. Ever since then I've been feeling very fatigued. I don't want to go back to my naturopath to get treated for Lyme now that I know it's a scam. But, might there be a reason that I am so sleepy? Some days I am sleeping 20 hours and can barely stay awake. I am seeing a sleep specialist, but I was wondering if the long term antibiotics had anything to do with it.

43 F, was diagnosed with BP II at 34 years old. My parents definitely both have some type of undiagnosed mood disorders but Bipolar runs rampant on my father’s side.
Currently taking 375mg Lamictal (extra 100 added because I use the Nuvaring), 900mg lithium, and 300mg of gabapentin. I had a pretty bad alcohol issue prior to January. I realized I went into mixed episodes when I mixed lithium and wine. So I switched to Whiteclaw and had no issues and now I just have not been drinking much. Like an idiot I was feeling relaxed the other night and thought it would be nice to have some wine to further calm down. Just had a glass. Last night, I drank the rest, and started getting super hopeless.
My issues with bipolar lead to my husband telling me he wanted a divorce 2 months ago. I was struggling a lot in the second half of 2022. I was weaned off Lexapro after taking it for 8 years. Historically, i do not do well in periods of adjusting meds. I was getting better by early January as I stopped drinking wine. But then the divorce happened (not officially but no chance of reconciliation).
My kids (13 and 15) knew he wanted a divorce before I did. They thought it was a good idea because of all of the fighting. My 13 year old still spends time with me but my 15 year old doesn’t even like being around me. I love spending time with them, and it’s the only thing that makes me remotely happy at the moment but they are just not that into it, which makes me less happy.
I literally am so miserable. The only thing that I like doing is going to concerts. So I bought four concert tickets for shows over the next two months. I just don’t know how I can sustain being so depressed. I am a mid-level practitioner in a profession I can’t get out of because of a bias/ stigma against. I hate my job and it’s actually physically injuring me. I’m in $400K+ student loan debt ($120K being the actual loan, the rest as interest). I wasn’t aware that I had bipolar when I started professional college. My career requires an entrepreneurial mindset and this motivation fluctuates. I’ve tried applying for jobs outside of my profession but I know I’m qualified for and I am always rejected or looked over.
I have no family or friends closer than 1000 miles that actually care about me. Just online friends. I live in a very expensive city near where my husband is from and cannot leave.
I just feel like I exist to bring in a paycheck and give my kids rides or help them as needed.
If you have gotten this far, thank you for reading. Would love any thoughts or advice.

I started taking lithium back in September and was weaned off Lexapro. I also take Lamictal and most recently, Gabapentin. I have felt more energy since coming off Lexapro, and have many moments of stability, but every time my dose goes up, I tend to have anger issues. Anger issues aren’t new for me and basically ruined my marriage. My husband blames the lithium. I feel like it’s helping. Any thoughts? My current dosages are 375mg of Lamictal (I use NuvaRing so it’s bumped up 100 mg); lithium (900mg); and gabapentin (300mg). I’ve been taking this level of Lamictal for 6 years, lithium for one week at 900; and gabapentin for like a week and a half.

Medical info: 25f, 5'8", 165lbs. History of migraine headaches (with and without aura) from 19-22, an eating disorder (ARFID that progressed to anorexia) from 12-15, very severe motion sickness as a child/teen, panic attacks from ages 8-18, and also I was dropped on my head around 2 years of age, and stopped recognizing faces after that (never had imaging done on my brain though, parents were both poor and medically neglectful). Currently I have moderate asthma (excercise and cold are main triggers), rapid cycling bipolar 1 with psychosis & ocd features (no episodes in almost 2 years now thanks to medication), PTSD (very mild these days but used to be severe), ehlers danlos syndrome (subtype unknown), POTS, and ADHD-C. I am also very near sighted and wear glasses. Meds are 2mg aripiprazole, 20mg Adderall XR, an inhaler as needed, and generic nuvaring. Some marijuana use as a teen. These days I have 1-2 drinks/week on average, a cigarette maybe a few times a year, and no other drug use. I have a shellfish allergy and I can't take lamictal due to developing all of the warning signs of SJS (incl. skin pain, eye burning, swollen lymph nodes, & fever) about 3 years ago, but I was told I never technically had sjs because I stopped the med before the blisters arrived.
The problem: Since November, I've started having very strange episodes, roughly every 1-2 months. It starts with my ears feeling weirdly full and itchy, and then several hours later I suddenly dissociate very severely (my brain and my body feel entirely separate from each other, like during a PTSD flashback or a panic attack, but there's no anxiety present) and speech, while possible, is difficult and stilted. After 30-50 minutes, I start to "zone out" I guess, where I basically just stare at a wall and I can't process anything happening around me or move. I can force myself out of this state after about 10-20 seconds. If something touches me I snap out, but if a body part starts hurting on its own from the position I'm in, I won't generally notice. This happens repeatedly for around 15-30 minutes, with me going into this state, forcing myself out, and then going back in & forcing myself out again.
Then, a wave of physical symptoms: hot flashes, nausea, gas pain, back/neck/abdominal muscle pain, and severe blood pressure drops where I get dizzy and lose vision (and once, my hearing turned to loud ringing) without a position change, but if I lay down it normalizes.
The gas pain slowly intensifies, as does the nausea (which is entirely separate from the dizziness). Sometimes at this point I get vertigo from moving my head or scrolling on my phone, but not always. My memory of these episodes then gets fuzzy. For the most recent one, I remember retching but not vomiting in the bathroom at some point with no memory of actually moving to the bathroom. I took my temperature for some reason and it was 98.0 fahrenheit. My next memory is being confused on my bed, trying to figure out where I was and how I got there -- I was able to talk myself through it out loud. My stomach hurts a lot during this time -- the gas pain coalesces just below my belly button and does not move until after the episode is over. The few times I've tried to go to the bathroom during these episodes I have retched, lost vision and hearing, and then lost balance/nearly fainted.
Sometimes I get very hungry, but consistently if I try to eat I get one bite down, feel incredibly full, and then a couple minutes later I am very hungry again. It cycles like this until I give up on eating and just deal with being hungry.
After between two and six hours of this (they've been getting longer on average as I've had more of them), I will slowly return to a normal mental state. The gas starts to move, and I burp/fart endlessly for like an hour & it hurts. I generally end these episodes both exhausted and unable to sleep, and my ears return to feeling vaguely full, itchy, and/or like they need to pop for a few more hours. Once I itched them so much on accident that I broke skin & had a scab in my outer ear canal for a few days. My neck is stiff and my back and abs are sore that night and the next day.
The episode (meaning the dissociation onwards) happens consistently after 7pm. I never seem to realize what's happening until the physical symptoms start -- I know something is wrong but believe it to psychiatric in nature until that point. It seems to have no relation to any substance use or exercise. When this first happened, I had just received my booster, but obviously it's been months since then so I think it's just a coincidence with the timing? My medications had been stable for over a year before this started so I don't believe it to be a side effect.
My best guess right now is "something neurological" and "maybe stress related". I'm moving at the end of the month to a new state and will be asking my new doc what they think once I have my first appointment with them, but I'd still just like to have some idea of what in the hell this could be in the meantime because it's both scary and extremely inconvenient. I'm entirely nonfunctional when this happens.

Long post, but it has a few moving pieces. <> :-)
When I was 21, I was placed on Ortho Tri-Cyclen to manage ovarian cysts. I remained on it for close to 20 years but stopped for a number of reasons in June 2018, when I was 38. There were periods where even on the pill, my cycle was awful, but only 10% of that time.
In May 2019, after about a year of being off the pill, my period started getting really bad. The first day or so, I'd get cramps down my legs, weakness, nausea, SO MUCH BLOOD, the whole deal. I was all good after the first day, so I just dealt with it with NSAIDs and rest. Over time it got worse and worse.
It took me another year to remember birth control helps with periods. But as it turns out, a psych drug I was prescribed while off the pill, Lamictal/lamotrigine, can be seriously affected by hormones, and loses as much as 50% of its efficacy if the patient is also on birth control. It's not a big deal to readjust my dose, but during the non-hormonal placebo week, the Lamictal level in my blood would nearly double and that would put me at risk of a psychiatric episode every month.
I went to the gyno and we narrowed it down to Nuvaring as it's a good continuous hormonal BC option that helps with period symptoms. IUDs were ruled out because while its a continuous dose, Kyleena can irritate my uterine fibroids and make period symptoms worse (according to the doc).
I'm 5 months into continuous Nuvaring use and while I did have one mini-manic episode while we got the Lamictal dosage sorted, the psych meds have been stable.
On the other hand, I've been bleeding in one form or fashion the whole damn time. Mostly it's been spotting. This month and last, I had several continuous days that felt like a period, but with less hellish symptoms. I know there's spotting and bleeding early on and if it was a simple 3 day period of breakthrough bleeding every month, I'd be ok with it I suppose, but 5 months straight???
How much longer do I wait to give up on this? I know up to a year may be needed but oy.
Also when I was on the pill, I did try to switch to other pills a few times but it went poorly and my then-longtime gyno and I decided I'm best on a high-dose pills. Are there high-dose pills that can be taken continuously?
Thanks in advance. If there are other posts it might make sense to cross-post to, please let me know.

TL;DR I’m in the process of getting off of Lamictal and onto Latuda. I need to stay on the hormonal contraceptive I currently use and have slipped into a depressive episode because the lamictal is no longer working due to the estrogenic properties of the Nuvaring.
I’ve never been on an anti-psychotic before. I’ve also been having sleep issues so I received a prescription for trazadone as well.

For the women on here, what has your experience been like with BPD and hormonal birth control? And for those who have had children, what was pregnancy like?
After spending a significant amount of time on and off of multiple hormonal contraceptives (a game I like to refer to as musical birth control), I’ve realized that hormones just fuck with me. There’s a significant amount of evidence that some even directly compete with medications like lamictal (the mood stabilizer I’ve been on for 5+ years now).
I went from being stable for the past 6 months to unstable and experiencing symptoms again after starting the nuvaring a couple of months ago. I felt a little off kilter but noticed something was really off when I felt enraged for 5 hours last weekend. The episodes have been popping up more and more lately so yesterday I asked my psychiatrist for help.
They prescribed me an as needed dose of Abilify, which I’m optimist about. The rage episodes have only happened a couple of times and I just keep to myself when I’m ramping up and use my DBT skills to try to come back down. They don’t help as much as I’d need them to which is what prompted me to ask for a different solution.
Is pregnancy going to drive me off the deep end? I’m planning on trying to conceive in the next couple of years and am admittedly a bit worried.

I used to have thick, long hair with normal fall out after a shower or brushing. I have been slowly increasing my dosage of Lamictal with my doctor for two years, I ended up on 125 mg a day. In February my stylist told me that she saw some thinning at the crown of my head and asked if I noticed any hair loss. I had been, but I can't see the top of my head and didnt think much of it. In the shower, after shampoo it would just come out, bunches of strands at a time . Not big patches in certian sections but a ton of hair from all over. I cut my hair to my shoulders to see if that would help slow down the fall out, but it didn't.
For reference I am 26 years old, female with Bipolar II, only taking Lamictal and Nuvaring for birth control. I dont smoke or drink, eat pretty healthy but dont work out a lot. I'd say I'm pretty average, and nothing in my genetics show female hair loss this early, if at all. I wanted to see if anyone noticed hair loss after taking Lamictal also? I have been under a lot of stress this last year and it could be that but wanted to see if there was any anecdotal evidence in line with what I've experienced.
I was on the nuvaring years before starting Lamictal and never had a problem. I stopped birth control in February to see if that was the culprit but alas, no change. I haven't stopped taking Lamictal but will definitely bring it up with my doctor for a possible med change if it seems to be the case. It has taken a toll on my mental health as I have a difficult time with self love and acceptance, so I'm trying everything I can!

TL;DR — If you are on Nexplanon, please consider the side effects!
I learned about BPD through Reddit of all places when a bunch of armchair psychologists threw out the term to describe a woman depicted in a meme. Out of sheer curiosity, I read about it on Wikipedia and was horrified when I realized most of the symptoms described what it was like for me to live every day.
I was officially diagnosed in 2016, started a mood stabilizer (lamictal), and got into intensive DBT for 6 months. It was during this time that I worked through a lot of childhood trauma and PTSD from early adulthood. I got better and better and eventually felt I was in remission. This carried on for nearly 4 years.
Birth control has many effects on women regardless of their mental health. Once I was on the mood stabilizer, I realized that I felt different when on or off of certain birth controls. This is because estrogenic birth controls actually inhibit the body’s ability to break down lamictal, and in turn, it becomes less effective. The most pronounced of these was ortho tri cyclen lo. When I stopped taking it, I noticed a huge improvement in my mood. Suddenly I was much more confident, could focus better, and felt more talkative. As someone who has had my fair share of adventures, I knew that being in a hormonal contraceptive was a necessity. I elected to go on the Nuvaring, which dampened some of the confidence/boldness I gained from coming off of ortho tricyclen lo. Still, I was happy, and if I was consistently exercising, I was doing pretty well.
I got off of birth control entirely for a while due to dating a woman and then dating someone who was waiting for marriage. When both of those relationships ended, I decided to go with Nexplanon, since it is a progesterone-based birth control and shouldn’t affect lamictal the way estrogen does.
Within the first few days of it being implanted into my arm, I felt enraged. I remember consciously saying to myself that I felt like my BPD had returned. Still, I was stubborn and wanted to stay on some form of birth control as I was in a relationship with a man.
Weird, BPD symptoms started popping up again. Uncontrollable anger, splitting, and feelings of emptiness. It cost me one of my relationships and it wasn’t until a couple of weeks ago when I realized I was about to lose another partner yet again.
It had gotten much worse. I began having dissociative episodes while arguing with my current partner nearly every day. Some of the arguments were justified. Others weren’t. Part of me wonders if the side effects became more severe after I lost weight. After getting Nexplanon my weight shot up to 145 lbs. I rapidly lost 15 lbs over the span of a month and a half or so, meaning that the dosage of hormone I was now receiving was most likely higher than it had been previously.
My current partner pointed out to me that his sister and ex had struggled with Nexplanon due to mood issues. I took a hard look in the mirror and realized that I was exhibiting symptoms of BPD again. I was ashamed of myself.
I will say that removing it has made a huge difference in my basal stress levels. I no longer feel like everyone is SO FUCKING ANNOYING/stupid/wrong all the time. I feel relaxed for the first time in a long time.
My point for writing all of this is to warn other women who are looking into this birth control. I’ve never been on anything that has made me so angry before. It was terrifying and my relationship is still mending because of it (and also for other reasons related to not disclosing my BPD). I’m back in DBT and looking forward to getting back on track.

So I’ve been on birth control since I was a teenager due to irregular and super painful periods. I switched to Nuvaring in 2017 and it’s been great. I’ve been on Lamictal for several months and I’ve been doing ok on that too. The nurse practitioner I was seeing specifically for bipolar said Nuvaring can decrease Lamictal levels but not the other way around. She retired and I got put with a new nurse practitioner at the behavioral health office who says Nuvaring AND birth control make each other less effective. My primary care doctor says she’s not sure how they interact, but then tells me I may need to switch to an IUD or use condoms. I’ve been with my husband for 10 years (we started dating early high school, I’m 26), so I’m flat out not using condoms. We did that for long enough lol. I really don’t want an IUD because I’ve heard horror stories about that too (I know the Nuvaring has its risks as well). I told my doctor I’d be willing to speak to a gynecologist to discuss my options. Has anyone else had experience specifically with Nuvaring and Lamictal?

So, I've been taking lamictal for 6 months now and it fits me very well never been better. Until, I decided to get back on nuvaring after a year off of it. Oh lord! I wasn't expecting what happened. I started feeling so sad and depressed. My depression was back, after all those months, I had forgotten how awful those feelings were. Well, mixt birthcontrol hormones actualy impact the effect of lamictal. So if you want to keep taking both, make sure your lamictal is higher than it should be, so it's the right dose. Also, lamictal can affect your birthcontrol, so you want to take it continualy and if any spotting happens, it's not working properly. I wouldn't want that to happen to anybody, I got really scared.

I’ve been on Lamictal since 2007. I was on BCP in 2008/2009 and didn’t tell my psych. I had an extremely hard time concentrating and ended up losing my job. All got better after getting off birth control but I was still dealing with the repercussions and didn’t connect the dots.
Fast forward to last summer when I began fertility treatments. They put me on a form of estrogen birth control for a month and I could barely function. I was subsequently on oral estrogen for several months and struggled to function. I couldn’t explain it.
I finally discussed it with my new psych and she informed me that estrogen significantly alters the concentration of Lamictal in your system.
We all know what it is like to miss a dose of Lamictal. But say you take 200 mg of Lamictal and then birth control...it’s like your now taking only 100mg. So, you still have enough in your system to barely get by but don’t know it.
I don’t have the option of discontinuing estrogen right now, so I increased my Lamictal from 200 to 300. It has helped immensely. Had I known this ten years ago, my life may be completely different.
I’m posting this because I was not with it enough to connect the dots on my own. And if this helps one more person, it is worth it.
Edit:
https://www.pharmacytimes.com/publications/issue/2012/january2012/oral-contraceptives-and-reduced-lamotrigine-efficacy
Another Article:
Oral Contraceptives Reduce Lamotrigine (Lamictal) Blood Levels
By MGH Center for Women's Mental HealthOctober 20th, 2008General4 Comments View Larger Image
Lamotrigine (Lamictal) has been effectively used for the maintenance treatment of bipolar disorder. Many women suffering from bipolar disorder are of childbearing age; therefore an adequate contraception is a major concern that needs to be addressed in this population.
Special consideration should be taken when patients taking lamotrigine plan to use oral contraceptives (OCs). Studies carried out in both healthy volunteers and patients with epilepsy indicate that OCs may alter the blood levels and efficacy of lamotrigine, decreasing its concentration by about 50 % (range 41%-64%) after just one week of co-administration. In addition, during the week of the inactive hormone preparation (“pill-free” week) of oral contraceptive therapy, blood lamotrigine levels rise and can double by the end of that week.
These studies showed that estrogen increases the clearance of lamotrigine by inducing the liver enzymes involved in its metabolism. More rapid metabolism results in lower, and possibly sub-therapeutic, levels of lamotrigine. Therefore, clinicians should consider increasing the dose of lamotrigine to compensate for the marked reduction in lamotrigine when a woman initiates treatment with an oral contraceptive.
In addition, there is a bidirectional interaction between OCs and lamotrigine, in which lamotrigine causes a small reduction (20%) in the blood concentration of progestin (levonorgestrel). While other anticonvulsants may decrease the efficacy of oral contraceptives, lamotrigine has not been shown to affect the efficacy of oral contraceptives. Nonetheless, women are advised to monitor for any changes in their menstrual cycles, such as breakthrough bleeding.
Women taking lamotrigine are advised to review the different options for contraception with their doctor. For a woman taking a stable dose of lamotrigine who wishes to initiate treatment with an oral contraceptive, the maintenance dose may need to be increased in order to maintain a constant blood level. The manufacturer recommends that the dose of lamotrigine should be increased at the same time the OCs are introduced and the dose escalated as needed based on clinical response. Also, it may also be helpful to measure a lamotrigine blood level prior to initiating treatment with OCs which can serve as a target level as the dose is adjusted. Dose increases of lamotrigine should occur according to the schedule recommended by the manufacturer.
If a woman is already taking an oral contraceptive and initiates treatment with lamotrigine, the dose of lamotrigine should be increased gradually according to the recommended schedule. However, the clinician should be aware that the dose of lamotrigine required for clinical response may be higher than in women who are not taking oral contraceptives. If the woman discontinues treatment with the OC, she may need to lower her dose of lamotrigine, as it will increase once the OC is stopped.
As there is a gradual and transient increase in levels during the pill-free week, patients should contact their doctor if they develop any of the following symptoms suggestive of lamotrigine toxicity: dizziness, lack of coordination and/or blurred or double vision. Although Stevens-Johnsons syndrome has been associated with rapid increases in lamotrigine blood levels, no cases have been reported in women taking oral contraceptives.
Given the complexities of these interactions between lamotrigine and oral contraceptives, some women may elect to avoid OCs altogether. Other hormone-containing contraceptives such as the Ortho-Evra patch, the NuvaRing and Mirena IUD may also affect lamotrigine levels. Thus, barrier methods and non-hormonal IUDs may be more attractive options for women taking lamotrigine.
M. Pia Rogines Velo Sardi, MD, PhD Ruta Nonacs, MD, PhD Hadine Joffe, MD, MSc

So, I talked to my OB about birth control. Ya' know as you do, and he told me to talk to my pdoc about if it would interfere with any of my medications. Well, I talked to my pdoc and he said that if I take any birth control pills I might have to up my Lamictal to 300 mg up from the 200 I'm currently on.
OK. Good to know. No pills for me. What am I left with? The Nuvaring. Got the ring, inserted it, and did a little research. Guess what becomes less effective? The Nuvaring. Called the OB's office and spoke to a nurse. Turns out I was wrong. The Nuvaring makes my Lamictal less effective.
Can I just live without worrying about throwing off my medication balance?
SN: After my second child IUDs aren't an option and I just checked and Nexplanon lowers the levels of the Lamictal as well.

age: 18 weight: 99 height: 4’10 sex: female blood pressure: low/normal medications: lamictal 50mg for a few days, seroquel 50 for a few months, .50 mg of xanax as needed, nuvaring birth control for 3 months. i have anxiety and bipolar disorder
last week i noticed a strange sensation in my right leg, almost like a dull sensation that wasn’t quite pain but a bit uncomfortable, but i put it off because i didn’t really think it was a cause for concern. yesterday i noticed the slightest small bruises forming on my leg, they don’t hurt when i touch them and i don’t feel a bump or anything, but i can see them. right now after exercising a yellowish bruise formed on my left leg and my foot and leg below the knee started feeling sore. i’m getting strange lumpy sensations on both legs but i can’t feel any lumps? wondering if it should be a cause for concern since i have been on birth control.

This is more of a rant than anything else, but I'm in a kinda foul mood today and just wanted to let off some steam.
Nightmares have been my issue the past couple of nights and it's not helping my Trileptal sleep deprivation. Went to bed at 3 am last night, had an alarm set to wake me up at 12, but I guess I shut it off when it woke me up, but I don't remember doing so. I ended up sleeping in until about 1:30 and it took about 15 mins to drag myself out of bed.
I know when I first found this sub, I saw people talking about the vivid dreams that lamictal can cause and it explained a lot. Found this sub about a year ago, but as of today, I've been on lamictal for almost five years and when I first started it, the nightmares were so vivid and bad that I slept three hours a night (while I was in high school; have no idea how I ended up on the honor roll that year) and ended up being diagnosed with insomnia because I was sleeping less due to said nightmares. They put me on Seroquel for that.
So, I've been having vivid nightmares the past few nights and though they really fuck with my head, I fall back asleep pretty easily, but this is the one that finally woke me up so I could start my day.
Slight trigger warning here. There's some sensitive content.
I dreamed my sister and I had to go to the hospital for some reason and my boyfriend came with us. I can't remember why we were at the hospital, but my sister and I both had to get checked out for something and the nurse was an older man who kinda reminded me of Santa Claus (Christmas is still on the brain). So, my sister was fine and dandy so she left and the nurse went to check on me, but he had me strip down for some reason... And yeah, kinda tried to assault me, but I got away. I stole his name badge that most hospital workers around here have and I ran to the front desk, crying and telling the receptionist ladies what happened and one of them looked at me and said, "Congratulations," and I remember screaming at her that it was something that she shouldn't congratulate me for as I have been assaulted in real life in the past. They also said they were unsure they could call the cops or security. I throw the name badge at them, and run outside saying that they should find the man and the moment I get there a cop shows up and I was telling the cop about the man and my boyfriend and I saw my boyfriend walking as I was talking about him and said, "There he is," but the cop mistook him for the nurse and started chasing him and my boyfriend started running for some reason like he needed to flee the law. We both chase after him and after finally checking up, he's tearing the plates off of his truck as if he's trying to get away and with the cop far behind me, I walk up to him and he's crying saying that he was being accused of hurting me and he wouldn't do something like that and as I went to comfort him I woke up and just thought one thing:
"What in the ever loving fuck did I just dream?"
So yeah, great way to start my day.
Onto the next topic, the medication interactions. I'm on five meds technically, Trileptal (for sleep), seroquel (for sleep), lamictal (for my bipolar), gabapentin (for my anxiety), and the nuvaring (for birth control purposes).
When I picked up the Trileptal after being put on it by my psych, they warned me that it could make my birth control less effective and while that shouldn't worry me too much because of safe sex and all, it bugged me slightly.
Went to pick up my lamictal the other day and low and behold, the pharmacist gave me another warning that I've just heard for the first time in two years since I've been on the nuvaring and that is that my lamictal can decrease the blood levels of my nuvaring and my nuvaring can do the same to the lamictal. All I could think of was "Fuck, they're just now telling me this?"
On top of that, doing my own research, my Trileptal can fuck with my Seroquel and make it less effective as well, which my be why I'm not getting a good night's rest though I'm sleeping 7 to 12 hours depending on if I have to work or go to school.
All this can make me feel is that my psych doesn't know what interactions they have with one another when she gives them to me and that irritates the hell out of me because those four could be messing with one another which is why I'm not feeling in a great state of mind currently and if she'd ever get back in contact with me (I made a post about this yesterday) it would be awfully helpful to my wellbeing.
Okay, rant over. I think I'm gonna eat something sweet and just kinda lay here and enjoy my day off since I have two 8.5 hr shifts two days in a row and those are exhausting.
If you read this mess of words, I thank you very dearly.

Hi all! First time poster in this sub. I hope this is the right place to tell my story. This post may end up being long
For reference, I am FtM (transgender with a “female body”). I have PCOS, a fear of pregnancy & overall dislike of children. I live in the southern US. (North Carolina)
I had my annual GYNO appointment a few months ago. I mentioned to my doctor that I wanted my tubes removed. To my surprise, she immediately said “if you’re 21 or over [I am] we can get that scheduled for you today”. Her only requirement was that I was of legal age (21 in my state). She never mentioned my partner and was more than happy to help with my insurance (it’s 100% covered. Thanks Aetna!)
I decided to wait a few months to ensure I would be able to finish my semester with no holdbacks. Welp, exams are over and it’s finally the week of my surgery!
I thought I’d post my journey my journey here. My pre op is in a couple hours, and I’ll have the surgery Monday, which is in 4 days.
In the next update, I’ll post the relevant questions I will ask, and her responses. After that, I’ll let y’all know what the surgery recovering was like!
Thanks for reading!
UPDATE: My pre op went really well! As soon as I got there I signed some consent papers that yes, I want to be sterile. There were a few longer packets to be signed that I didn’t read (oops). Then I asked my doctor the questions I wanted.
Q: When can I masturbate again? I use a vibrator is that okay? A: As soon as you feel ready. This could be as soon as the day of the operation, as long as your wounds are messed with.
Q: When can I have sex again? A: Same as masturbation. Whenever you want.
Q: When will I feel back to normal? A: You’ll feel more like yourself within the week, probably sooner. After two weeks your wounds should be completely healed. Do not lift anything heavier than a jug of milk for 6 weeks.
Q: I use the Nuvaring, can I keep it in during my surgery? A: Yes. I will only be going into your vagina to lift the pelvis.
I’ve been instructed to shower with antibacterial soap the night before and the morning of the operation. I was given special soap to use, let sit on my body for 5 minutes, and then rinse off after the first soap. I can only take some of my medications in the morning, because one is a stimulant and we don’t want to risk the other. My SSRI and my Lamictal are the ones safe to take. I vape (I know, I know) and I’ve been told not to do that the morning of, but this weekend is okay. This is just the normal “I’m going under for an operation” stuff though. I’ll be given 5 days of pain meds (the max dose for my country) and I’ll be taking ibuprofen and Tylenol round the clock in addition (as per my doctor).
After the visit with my gynecologist I went to get blood work done. I signed some more papers, had the most painless blood-taking in my life, and that was it!
I’ll arrive at 6am on Monday for the operation! Obviously someone is driving me to and from. I’ll update again afterwards.
UPDATE 2:
I woke up early this morning to take an antibacterial shower. First with regular antibacterial body wash, then I had to let their special kind suds up and sit on me for 5 minutes. Once showered my mom took me.
We waited about 10 minutes and were taken back. I peed in a cup (pregnancy test), took a towel bath that made me reeeeally itchy and chatted with my mom while we waited.
Soon one of the doctors gave me something for my nerves. After that, Dr Wellbaum arrived and asked me one last time if I really wanted this. “No kids ever?” Never. “Are you sure?” Positive. We both smiled. I signed my last paper, and we were ready.
My mom started crying. I did too. I know she didn’t want me to get this done, but she supported me anyway. I’m tearing up a bit now.
The nurses wheeled me off and I told them I was nervous. I told them my mom didn’t want me to get this done (like I just told you). They said it’s my body. I smiled and I knew they were right. My mom must’ve known too, because she actually took me. This part was the only bit that was emotional during today.
I was helped on to another operating table, I remember the oxygen mask and then I was out.
I woke up with minor pain on my lower stomach. I just have two dot-like ‘wounds’. IV was taken out. I changed clothes with the help of my mom.
I had some pain getting in and out of the car. Coughing isn’t fun (I’m healing from a sinus infection arm) it’s been less than 10 hours since my operation and I already feel much better.
I’ve been able to walk around—getting up isn’t too fun, but its overall the easiest I’ve been able to move after any surgery. The pain meds are working wonders, on top of an easy surgery, so I feel very relaxed and good
My laparoscopic bilateral salpingectomy was a success. I’m now resting and so so happy with my decision.
Sorry for such a long post. I remember being so concerned about what would happen during the operation and not being able to find any detailed break downs of what to expect, so I thought I’d make my own for anyone in the future who needs it. This is just my experience. I’m in North Carolina. My doctor was Nicole Wellbaum. She’s been insanely supportive and kind during this process and made it an absolute breeze.
UPDATE: I’m on my third day of healing (counting the day of my surgery) and I feel very good. I’m walking around normally, eating normally, etc. The only issues I’ve run into is some minor discomfort when doing certain movements, but that’s to be expected. I finally built the guts to look at my “wounds”. Two small incisions on the lower belly, and one in my bellybutton! They’re healing wonderfully. I was even able to drive today.
I’ve had some minor spotting (via my vagina) but it’s almost all gone.
I suspect I’ll only get better as time goes on. I genuinely can’t believe how good I feel.
UPDATE 4: I’m almost a month post op. I’d like to clear some things up!
The Spotting was actually my period. My doctor removed my nuva ring (my form of birth control that lives in my vagina) and didn’t put it back in/tell me. So I can’t be for certain what caused the Spotting.
My incision in my belly button got infected—the stitches came loose and I don’t think I was doing that good of a job of cleaning them. Oops. It’s a very minor infection and should be gone soon! I was put on antibiotics and feel fine.
Everything else is normal. I should be able to lift things normally by the end of the month!
Emotionally, I feel freer than ever. I no longer have to worry about pregnancy and I’m so happy. My “abortion fund” is now regular savings, which is so comforting to have.

I APOLOGIZE FOR THE INFO DUMP AND MASSIVE WALL OF TEXT GAHHH!!
Relevant: 22female, Repeated clinical diagnoses for: ADHD-PI, Anxiety, Bipolar I with severe rapid-cycling, and moderate OCD tendencies. Currently on Nuvaring, 300mg Lamictal daily, and a varying dose of Vyvanse. Have tried Adderall before and just dropped 18mg Concerta 5 days ago. I have an EXTREMELY high medicine reactivity/adjustment and have done extensive genetic testing to research this due to my crazy med reactions. 20 days on Prozac, 5 on Wellbutrin, 5 on Cymbalta, etc. before those reactions became nearly-life-threatening. I'm the fucking cosmic exception to every recommended/expected/scientifically-accurate adjustment period. It makes any med trials really dangerous because it throws my life into chaos every time and makes me super nervous about my bipolar rapid-cycling risk when I stray from my routine.
My main ask here is regarding my current attempt at Vyvanse. Due to my reactivity, my psychiatrist is having me start at 10mg and do 10mg increases every day to find my "peak" dosage. Once I pass that sweet spot I will take it back to the previous dose and try that for a while. I haven't seen anybody else doing this on the sub yet (please correct me if I'm wrong) but I truly don't need the standard week-long dose adjustment, one day is sufficient. I am quite skilled by now at identifying placebo and evaluating/differentiating between medicine effects vs. all the other regular stuff.
I definitely had the expected appetite decrease on 10-30mg and was quite happy with that as it mainly curbed my binge eating to more appropriate portions and I need to lose weight anyways (have gained about 70lbs since beginning meds 2yrs ago). But today (Thursday) I got the "food is absolutely repulsing and I can't swallow a single thing" problem. No breakfast, maybe a 5th of a plate of spaghetti&meatballs, and then I forced about 300calories of almonds around 11pm because the Vyvanse had worn off enough to reveal how no food had trashed my body today and almonds are all I have available tonight. Plus Lamictal on empty stomach and I really need to not throw that up. I was totally unprepared for this and had the oh shit moment around lunch today.
I am drinking a TON of water though, no problems there.
I have poured through tons of Vyvanse posts here and am really anxious to begin implementing all of your wonderful appetite suggestions ASAP! (I won't likely get to many of them for a few days yet, unfortunately). Planning on finding a banana and a protein bar in the morning, at least.
I am at a loss though for how to limit life interference right now. I'm very responsible with my meds I always try to stage my med trials for times where I'll have consistency in my life so I can gauge the medicine itself and limit side effects interfering. But there's no way in hell to do that right now.
I gave blood the weekend before my psychiatrist decided on this switch and I'm just today getting past the residual fatigue and dehydration. I am starting Invisalign on Wednesday and am aware that I will likely eat less due to the lifestyle shift (I'll only have two hours every day to eat all meals and do oral hygiene, and need to brush between every meal; no snacking). I will also effectively be a caretaker for my mom a week after that while she has a 6-8 week surgery recovery and I can't risk being wildly cranky or emotionally unstable.
Knowing the appetite effects of Vyvanse and my history, I really wanted to get in this trial before those new influences. But this means doing this while traveling for business and having little control over my meal options (and still slightly off my game with the blood donation). The business trip will continue through Tuesday. It's also very difficult to get proper sleep (not insomnia related) due to travel schedule and the insane nausea tonight. Oh and I cut caffeine recently, which is great for stimulant usage but sucks for withdrawal adjustment. OH and I'm allergic to most nausea relief medication so I can't do much when the lack-of-eating-induced-nausea wave hits me. OHHH and I have a knee injury so getting cardio in has been very difficult, suggestions VERY WELCOME on this front. I know exercise is key to managing basically everything with my situation and am feeling the loss heavily.
Aside from the appetite problem I have also found that if I don't overtly avoid hyperfocusing it ends up destroying my day. Vyvanse has taken hyperfocusing to a whole new level for me; the duration is much shorter and intense (usually about 8-12 hours or however long it takes to complete the task, is now a firm 4 hours) and I have a horrendous crash afterwards. Extreme fatigue, persistent headaches, and complete inability to function. The nature of my job pushes me into hyperfocusing more days than not because it is all problem-solving and that's my vice (but my favorite hobby too! Yayyy...)
Given all of this I would have dearly loved to postpone this switch but I couldn't deal with the Concerta effects anymore and can't afford going solo-Lamictal because I will be useless at work and am way behind on a major project only I can complete.
My metaphorical mole hills are quickly becoming mountains but I'm refusing to panic and am reaching out instead before this gets out of hand the next few days.
Very long story short: this is not going well at alllll and I am struggling to cope with this. I have a checkup on Wednesday so I am going to soldier through til then, mostly because I am really loving every other effect of Vyvanse so far and it's having a great impact overall. I think I would normally cope well with the appetite problem and fatigue given my usual methods but that's so not the case here.
Again, all the food tips have been awesome and I don't really need more help with what to eat/how to eat/when to eat/etc. I guess I'm asking for more of a "how do you survive when your life gets in the way of all your regular coping methods and effectively forces you into a severely negative relationship with your medication? Help me survive until I can do the smart things please!" Or even just some virtual hugs and support.
Finally, I again apologize profusely for the info dump and the wall of text. This community is so helpful and supportive and you all seem like the perfect group to help me figure this out. Any suggestions besides "stick it out for the rest of this week and good luck in the meantime" or "implement all the appetite and sleep suggestions already offered here"? Thank you in advance!!!!!
Tl;dr my life has turned upside down and is causing bad Vyvanse side effects while trying it for first time, need coping methods until life turns right-side up.

Hi all,
I have been taking a combination of lithium (900mg), latuda (80mg), and wellbutrin (100mg). I have been stable and without episode for the past 7 months (thank god). My new psychiatrist thinks it's time to get off of lithium, being that it's dangerous, and switch me to lamictal.
I have a couple questions:
1) those of you on lamictal - be honest - do you like it? Has it helped you?
2) I heard lamictal interferes with birth control pills - is this true? Do Other types of birth control work (ie: nuvaring, IUD, etc)?
3) Do you think it is a good "switch" to go from lithium to lamictal?
Thanks in advanced for reading and for your thoughts. :)