Lamictal maintenance

I have been struggling for MONTHS when it comes to eating enough. I’ve lost 20 pounds (for context, I am petite, 24 year old female, so this is substantial). I’m on 200 mg lamictal and 30 mg latuda. I have a hollow feeling in my stomach but when I do eat, even just a little bit, I feel so nauseous. I’ve started tracking calories (just to get a baseline) and I’m eating about 1400-1800 calories a day. For my height, weight, and exercise routine, I need to be eating 2,200 just for weight maintenance, but my goal is to gain weight, so ideally I need to work up to eating ~3,000 calories. My mom thinks it’s an eating disorder but I am convinced it’s a symptom/side effect of bp2 and ADHD (my psych says this could be due to lack of executive function).
Edit: I am vegetarian :/
Can anyone relate? Does anyone have any advice on how I can convince my body to eat more? Thank you so much

Context: I have dx of bipolar 2, ptsd and ocd.
The tiniest little thing happened recently that hurt my feelings, and triggered feelings of shame and worthlessness I have been sobbing off since then. I feel like I suck at everything and everyone is so much better than me 😭 I feel like people are glad when I leave. My current antidepressant (lexapro) is max dose and my lamictal is above maintenance dose. I’m taking as much medication as my stomach can handle. I have been seeing therapists for 25 years. It isn’t really helping. What else can I do? I cried in public not long ago just because someone raised their voice at me. I’ve never done that before. I am just raw all the time. I need it to stop 😢

My feelings were hurt yesterday over something kind of silly… but it triggered feelings of worthless and shame. I feel like I suck at everything. Everyone is so much better than me 😭why am I so stupid? I feel like people are glad when I leave. My current antidepressant (lexapro) is max dose and my lamictal is above maintenance dose. I’m taking as much medication as my stomach can handle. I have been seeing therapists for 25 years. It isn’t really helping. What else can I do? I cried in public not long ago just because someone raised their voice at me. I’ve never done that before. I am just raw all the time. I need it to stop 😢 Edit: added info

Hello all,
I have not been as active in this community as I should be, yet I have interacted with many in DM's, most from seeing my posts and reaching out to me to hear more of my story. I'd like to introduce myself, tell my story as quickly as I can, and most importantly, see if there's any others out there that do beef only at a high fat percentage for mental health. I need others in my life on the same path to keep me accountable. Also, helping others helps me greatly.
I urge you to take a few minutes and read what I have written. I know it is long, but it just may be worth it and make a difference in your day or even your life.
I am a male, 47, 5’6”, 150lbs, married with one kid, living in NJ. I have suffered mental health issues since I was a kid, but started my first treatment at 13, which was for my most recurring and prominent symptom: anger. My other prominent issues are irritability, depression, and a sense of wanting to die, but not actually kill myself, just yearning for my suffering to end.
When I am off, I am a huge jerk, I yell at my kid and our relationship is greatly strained, I am mean to my wife, I procrastinate and can’t start projects, and if I do, I don’t finish them; if a stranger in a parking lot who glances at me for a split-second pisses me off, I want to know what the F they are looking at and wanna go kick their you know what. Life can feel impossible, and I hate it and myself so much.
When I am on, I am happy and calm, I handle my kid’s issues with ease and we are best buddies, I am friendly to my wife, and that same passerby in a parking lot gets a smile from me and I am super-friendly. I tackle a to-do list with vigor and do everything from start to finish. Best of all is life is so easy and I am excited for every minute. I love living and myself!
From age 13 until now, I have suffered substance abuse, attended two separate IOP's (intensive outpatient programs), done many, many years of therapy, and taken all the available drug types. The only meds that ever worked were seizure drugs, and Lamictal was the best for me. I also started smoking pot when I was 16, which was the only thing that ever made me feel ‘normal.’ Unfortunately, I am a huge addict, and I did lots of other drugs for a long time, but pot was always my main drug of choice. It took me a long time to realize the anti-seizure effect is why deep ketosis works for me. The pot strains that worked best for me are the ones used for seizures, then add in Lamictal, and the diet; they all work in similar ways. Had a major light-bulb moment when I put that together.
As for my diet, I was vegetarian/vegan for 20 years, the last few were raw vegan. As I ate more plants, and less animals, my physical and mental health declined, but I just thought I needed to find the right plants or supplements. I started to add meat back about 10 years ago, but still ate mostly SAD, and because I smoked pot to feel well, I’d eat massive amounts of carbs, mostly late at night before bed. For a few years my annual blood checks showed I was prediabetic, Fasting glucose was 96, then 104, with 106 being my highest.
When my kid was born in 2016, I was powerlifting heavily and eating low-carb to attempt to stay lean and get stronger, but I didn’t really know what low carb was back then, I just knew when I tracked my food intake and kept my carbs below a certain amount, I felt better and didn’t gain weight. Those of you who know, having a kid changes everything, plus, two months after she was born, I had a nasty fall off a ladder, dislocated my hand, and shattered my wrist; it was severe enough that they considered fusing my hand to my arm, which would mean I could no longer bend my wrist. Luckily, I am fully recovered, and it does not bother me or hinder me in any way; that’s a whole other story.
It took 2 years to recover from that injury, and during that time, we were tight on budget, so I was eating pasta and homemade sourdough bread every day. In addition, I couldn’t exercise how I wanted to. This all led to putting on 40lbs, having terrible skin, eye, and other issues, and I was angry, miserable, and wanted to die. Man, I still miss the process of making sourdough, I was 2-years in at that point, made two loaves every week, and the starter was like my baby.
Anyway, in 2019, I had enough of feeling so terrible and remembered that lowering my carbs helped in the past, so I started that. I removed bread and pasta, tracked carbs, and I lost 20lbs quickly, and felt much better. I naturally got myself down to what might be considered paleo, and ate things like meat, eggs, avocado, nuts, and cheese. I vividly recall hearing Vinny Tortorich, the NSNG guy, on Adam and Dr Drew’s podcast talking about a carnivore diet, where people ate only meat. It sounded like the most ridiculous and impossible idea, but the thought stuck in my mind. As I began to eat more meat and less plants, I couldn’t ignore that I felt so much better, and life was getting better and easier. So, I followed that path.
Within 6-8 months, I was almost full meat-only, with some butter and cheese and maybe other little things added in. I lost another 20 pounds and felt awesome mentally. However, this is when I started having electrolyte and energy issues. I discovered I needed more fat and started buying fat trim from my local butcher. This is also when I started to see a carnivore presence online and listening to Paladino, when he was still actually a carnivore, not the carnivore-ish thing he does now, lol. Because of him though, I began to eat organs and seek out as much of the animal as I could. I still regularly eat liver and heart, and marrow and brains for their mostly-fat content.
I don’t want to bore anyone with too much detail, so I’ll skip ahead. I’m passing over so many details of my journey, and if anyone is interested in chatting about it, please feel free to reach out. Over the next 4.5 years, until now, I have been experimenting heavily and have found that beef only, at a fat ratio of around 90%, or higher, is what works best for me. Digestion and skin are perfect, and mood is bliss. Dairy, wheat, and gluten, cocoa, and sweeteners like monk fruit and stevia are some of my worst offenders. If I eat those items, within 48 hours, my anger and skin issues return, along with many other symptoms including pain in my healed wrist and other body parts. When I add in pork or chicken, even pasture raised, I will have some type of issues and it is less than optimal. This is how I found my HFBO path.
I have had periods of time where I felt the best I ever had in my life. I am a different person when doing this right, and can be a great father to my kid, which is the most important thing to me. I am not perfect, and I am still figuring things out and stumbling along the way, but I have a formula that works very well for me, only if I stick to it.
Here’s my key ingredients for success:
1. HFBO / high-fat beef-only, 90% fat, at or above maintenance calories so I do not lose weight. Ketones at or above 1.2.
2. Beam minerals, both electrolyte and trace mineral liquids, the capsules, and the sprays.
3. Physical activity and sunlight, with sprinting as my main exercise. (shout-out to Dr Shawn O’Mara)
4. Enjoy life and have fun.
Currently, and for many years, I do what is called OMAD, oh how I hate names and labels for everything. I was doing OMAD loooong before I knew it had a name and was a thing. I didn’t wake up one day and say, yeah, I think I’ll try OMAD next, I just naturally gravitated towards it. I had a 6-month period 2 summers ago where I did rolling 48s, and I have done many extended fast of 3-5 days with my longest being a few hours shy of 6 full days.
Unfortunately, I don’t always stay on track. Sometimes all it takes is a cold and being tired for my body to crave more energy, and if I am not careful, I either eat too much meat/protein, which, yes messes me up, or I eat carbs. Last week, this happened, and I had two days of eating stuff I shouldn’t. My remedy to get back on track is fasting. I started fasting on my own, before I knew it was a thing, then I found Cole Robinson and the snake diet. I love the Cole of 5-7 years ago when he was calmer and did hour long videos with so much info.
So right now, I am 90 hours fasted, and I feel amazing. This has been my best extended fast to date, and I have done lots of them. I credit Beam minerals for this, so anyone with electrolyte issues, like cramping or headaches, please check them out. I am full of energy and about to ride my onewheel for an aggressive 20 minutes on some trails, which, for those who don’t know, is physically demanding, then I will kayak as exercise on our local creek.
Check out my glucose and ketones numbers from the last few days, measured on a keto mojo:
Sunday morning, last day of eating crap:
Glu/Ke
105/0.5
Monday, after a 24 hour fast and working hard in the sun:
69/0.7
Wednesday evening, after 72 hours fasting (lowest glucose reading ever):
42/2.7
Thursday morning, after 85 hours fasting:
53/3.8
Plus, I am down 6 pounds, back to my weight before I ate way too much and too much junk for a few days.
Ok, let me wrap this up. I have met some incredible people here. One guy is close to me in Long Island, and I have become great friends with him, we talk all day every day. I love this dude, and while he is brand new, and is just starting to carve his path, he helps me more than he could ever know. Another guy I just met from Ca, is amazingly just like me and eats HFBO. We just spoke on the phone yesterday, and I can sense a great friendship building there. There’s a woman in Canada who does beef only, and we have spoken, but not as much as I’d like.
The LI guy and I have discord servers set up to bring us together. For him, he’s in need of others just staring out. I am there and willing to mentor and help in anyway I can. For myself, I want to interact with people that are trying to do what I do, and also expose the community to a version of metabolic therapy that has done amazing wonders for me. I don’t see anyone talking about HFBO as an option, and I feel it could be a major game-changer for many suffering people. So, let’s get the word out and bring like-minded people together! Feel free to reply here or DM me.
As a side note, my child also suffers similar symptoms and we have tried several meds. It was the typical med experience and only work somewhat for some of the time. She’s only 7 and suffers greatly. The next move by her neuropsychologist was to put her on SSRI’s, but my wife and I agreed we didn’t want that, especially after some terrible med experiences with her already. With the help of her neuropsych, she’s been on a therapeutic ketogenic diet since the start of school year and has experienced so much improvement. We keep her fat 75-78% and she still eats up to 50g/carbs a day, sometimes more. We track her ketones on a Biosense breath meter 2x/day. If anyone is interested in chatting about that, hit me up. My kid and I are starting a YouTube channel to share our experience along with the other typical social accounts. I see a void in the community for this content and feel we could help many people.
If you made it this far, I sincerely thank you. Writing this post has helped me and you reading also helps.
Edit: I have my socials setup and my handle is @MT4MH on Instagram, Facebook, and X. Same on YouTube, where I posted my first video, which is me narrating this intro with extra content added in. My email is MTforMH@gmail.com.
MT4MH = Metabolic Therapy for Mental Health

28M On hydroxyzine, Zyprexa, klonopin, and lamictal for symptom management.
My neurologist has determined that my encephalitis is strictly t-cell mediated with no autoantibody involvement.
I was prescribed 2g/kg of IVIG gammagard every month (induction dose is same as maintenance).
I know ivig is more effective against b-cell mediated encephalitis, but can it be effective in strictly T cell mediated AE?
Thank you for any input.

Hi there,
I was put on Lamictal for my Bipolar but also have OCD. I started 4 months ago at 25mg, then up to 50mg after a few weeks then up to 100mg. I started to notice my intrusive thoughts and OCD rituals getting worse as the weeks went by and with each dose increase.Just wondering if anyone else has experienced this while on Lamotrogine?
I was hopeful for this med to work for me as physically I am not experiencing any negative side effects like weight gain, nausea, excessive fatigue or restless leg syndrome that I have had with other antipsychotic or mood stabilizing medications. We are weaning me off it and am now down to 50mg again. I have noticed my OCD rituals and intrusive thoughts lessen. I believe my psych said that to be used for mood stabilizing for BP I would need to be on at least 100 mg. Just wondering if anyone else has had success at just 50mg for BP? They want to switch me to Abilify but I am terrified of the potential weight gain as I was previously on antipsychotics a few years back and gained a ton of weight. I am a very small person and diabetes runs on both sides of the family so maintening a healthy weight is vey important for me. The psychs goal is to eventually have me on a mood stabilizer or antipsychotic and ssri for my OCD/anxiety. I'm feeling very overwhelmed with trying to find the right medication combo and feel a lot of shame and guilt since I was off all meds for more than a year and I was semi ok but was re assessed for BP and am told I do have it and if I am not medicated I can relapse which I know is a risk...just feeling very frustrated.

I did well on Lamictal for many years, then I had a long mixed manic episode that got me the upgrade to BP1 and added Lithium a year ago. Still recovering from.this mess. Due to side effects I decided to lower the.dose to 0.4..Maybe I will stop all together. Which is stupid, but I just cannot put up with the latest side effects.. I also refuse APs as maintenance med..
My psy took note of my decision and wished me "good luck" this morning. I feel I am on my own now.
I have zero commorbidity, 20 years of therapy, stable happy life otherwise, and proper (mostly mixed hypomanic) episodes only every few years. Anybody BP1 managed wirh maintenance Lamictal only? or Lamictal with low dose 0.4 Lithum? Please tell me it is possible.

Bipolar 2/BPD. Been on 50-200mg IR Seroquel for 6 years (mainly for sleep). Just put on 300mg XR a week ago for acute hypomania/irritability. I also take Lamictal, but I'm actively trying to wean off it as my doc and I think it might be the source of what's causing my mania and irritation. I've been on Lamictal since May 2023 and my anxiety has increased 10 fold.
I'm wondering if any of you only take seroquel as monotherapy and at what dose?
I love the way 300mg xr is making me feel...my thoughts are silent, i feel "calm"/maybe a little emotionally blunted, not too anxious but make my self anxious because I feel so calm, almost like I smoked some weed...but I think the dose might be a little TOO much (or I'm just getting used to it still and my body will adapt after a month or so)...
So, I'm wondering if any of you have decreased the xr dosage for maintenance purposes and just use seroquel as monotherapy after manic episodes subside? Or do most of you have to take a mood stabilizer also?

I’ve been on lamictal for around 6 years now. Initially I got on it for anxiety around food and eating. I’m bipolar2 and I had it paired with trintillix my first 3 years until I started getting depression from it.
Ever since I got off trintillex it feels like my anxiety and mood swings have gotten worse over the past few years. I get extreme anger and irritation if I haven’t eaten in a while, having hypomanic highs but no depression, and panic attacks when I have big events coming up.
My ocd has also gotten worse on this medicine. I’ve tried so many ssris and an snri but they always lead to me getting depressed after a few months. My psychiatrist now wants to put me on lithium but I really don’t want to deal with the high maintenance of it.
Does anyone have any experience with these side effects?

Hi friends, I started Spravato about a month ago and have been really experiencing the benefits. I have four more sessions before I decide whether I want to do maintenance. I wanted to ask whether anyone has had experience discontinuing other psychiatric medications while going through and/or after ketamine treatment. I’m currently on Viibryd, Mirtazipine (Remron), and Lamictal. Obviously, discontinuing any medication will be in collaboration and in discussion with my psychiatrist, but I’m curious to hear people’s experiences with this. Thanks :)

For context, I'm 23F and I was started on Zoloft in January. I started with 4 days of 25mg, then bumped up to 50mg nightly.
I have been on various psychiatric medications of various classifications for over a decade. My first psychiatric medication was Prozac at age 11 or 12. At 13, I was started on Risperdal, my first antipsychotic. Over the years, I've taken a LOT of different medications for varying periods of time.
Psychiatric medications I've been prescribed and taken through the years: SSRIs: Prozac, Zoloft, Lexapro SNRIs: Cymbalta, Effexor Antipsychotics: Risperdal, Geodon, Ability, Haldol, Saphris, Latuda, Zyprexa, Seroquel Mood stabilizers (of various drug classes): Lithium, Topamax, Lamictal Stimulants: Adderall, Ritalin, Vyvanse Anti-anxiety (also various classes I believe): Buspar, Gabapentin Benzodiazapines: Klonopin, Ativan, Valium, Librium Sleep-aids (various classes): Trazodone, Restoril
The extensive amount of different medications I've been prescribed throughout the years is due largely to an uncountable amount of psychiatric emergencies I've had throughout the years, as well as providers trying different medications cocktails through trial and error to figure out what works best. Uncertainty in a specific diagnosis was also a large contributing factor through my teenage years, since many of the symptoms that needed immediate treatment were also not commonly diagnosed at the age of my onset. Plus, five 5250 holds ranging from 3 days to 12 days (averaging around no less than 9 days per admittance) tends to be a big factor, since in my experience, physicians tend to prescribe a lot of things as trial and error while you're in a state of emergency whilst also being under the 24/7 supervision that comes with psychiatric hospitalization.
To this day, I'm not entirely certain what my exact issues are, even though I've been seeing the same psychiatrist for over five years routinely and I had only seen one other prior for around 4 years (she was pediatric only, so I switched when I turned 18) but this is my current diagnostic list:
-Schizoaffective disorder, bipolar type -Borderline personality disorder -Generalized anxiety disorder -PTSD -ADHD -Bulimia nervosa (formerly anorexia nervosa, and even more formerly, ARFID) -Substance use disorder (mostly in recovery) -Specific phobia (emetophobia)
While this is my clinical list, my day by day struggle is most heavily with BPD & severe anxiety. I've been diagnosed with GAD since elementary school age.
As you can see, definitely a lot of different factors in what might have caused the reaction I had to Zoloft, so I'm not positive that it was only the Zoloft and that's why I wanted to include all of this background information. I know each case is super different, and I don't want to scare anyone who is taking Zoloft or may soon be prescribed with it by making a generalization about the medication itself. So many factors go into this including genetics, medication and mental health history, reason for use, dosage, other medications of any kind or supplements, etc. It's super different for everyone, and I've clearly got a lot of things to consider as factors, but I wanted to share my experience with Zoloft since I'm wondering if anyone else has dealt with the same.
At the time of being prescribed and starting Zoloft, I was taking it in conjunction with my last few days of weening from Valium, along with a medication called benztropine which I've been on for a few years now to control unwanted movements and tics I've developed from other medications I've taken in the past (the term is dystonia).
I took Zoloft for around two months, and at first the side effects were very minimal if any. A few days in, I began having severe panic attacks multiple times per day, which I hadn't dealt with in years. Although, I'm pretty positive this was due to the weening off of Valium. I'd been prescribed daily benzodiazapines for the last few years, and weening off them is extremely difficult, so the return of the symptoms they had originally been prescribed for was expected. I ended up needing an urgent, day-of appointment with my psychiatrist around a week and half or two in because the amount of panic attacks and the severity of them was very quickly causing my mental state and life in general to deteriorate. I wasn't able to attend classes (university student) or even leave my dorm for a short walk or a drive to the grocery store without having a full scale panic attack. I wasn't able to eat much or sleep much and I felt very ill all the time from the amount of anxiety I had. I tried taking CBD gummies for about a week, but they didn't do much of anything. My psychiatrist put me back on my previous dose of Valium and instructed me to continue with Zoloft. The plan is to attempt weening again in the summer when I won't have such a busy academic structure to adhere to. I really dislike being dependent on benzodiazapines and I've tried multiple times throughout the last few years to medically ween and use alternatives like gabapentin and Buspar, but they've never been effective enough for daily functioning unfortunately. It's still something we're working on. It is noteable though that I haven't had any significant dose increases on any of the benzodiazapines I've been prescribed long term, the only times I was ever upped in dosage was for short-term PRN during crisis times. Other than that, I've only been taking the typical starting or maintenance or whatever dose daily.
Upon getting back on Valium, my panic attacks lessened in severity and frequency again fairly quickly and for a week or two it seemed the regimen in general was working for me. That is, until I started experiencing sudden and servere brain fog. I've experienced brain fog many times before, but the level of severity was terrifying, especially because of the sudden onset of it and the very rapid deterioration in the following few days/week or so. Despite all of my anxieties day to day, I'm typically a very clear thinker. I do tend to have attention problems (typical from my ADHD) but aside from that, my brain has been very active at all times for my whole life. I'm always thinking about something, usually a LOT of things at once, actually. Within a few days, I went from that baseline to having so much brain fog I was unable to have a train of thought that lasted longer than maybe a minute at best, and if anything happened around me (i.e. someone else talking, a noise, etc.) it would just completely derail immediately. Then the next moment, I wouldn't even remember remotely what I was thinking about or talking about. I had increasing difficulty following day to day average conversations. My fiance and I live together and we are always chatting about all kinds of different things. It quickly became hard to even follow or hold a basic conversation with him, the person I know best in the world. This caused me terrible fear and anxiety and meltdowns, I was worried I was losing all cognitive ability permanently and I was just terrified that I could no longer hold conversations or keep my thoughts even remotely straight. My paternal grandmother has Alzheimer's, and I begin to panic even more since I realized a lot of what I've heard from family that happened to her as it progressed mirrored what I was going through (even though I'm only 23.)
I attempted to research and find reason for why I was quickly losing my cognitive abilities, but even this proved difficult since id often open Chrome on my phone to look up a question I had just thought of, and by the time I opened the browser I had no idea what I was even going to look up anymore. I eventually thought about googling Zoloft and brain fog, and found a decent amount of people experiencing similar. What scared me was that a lot of them said even if it lessened, it hadn't completely gone away and they were years into treatment.
I was so terrified that I quit Zoloft that night. I never took it again. It's been a few weeks and my mind is back at baseline, which I'm so grateful for. It was extremely terrifying to go through, especially since I'm in college and that requires a lot of clear thinking. I was terrified about not only failing classes this semester and having that drop my GPA and result in losing honors status or scholarships, but also that I may never get my cognitive function back and be able to complete my degree, ever. It was so scary.
I'm sorry that this is so long, but I wanted to share my experience, and see if anyone else has had similar issues and how you've coped with it. And of course, I definitely DO NOT recommend quiting a medication before talking to your care team. I'm well aware there's a lot of risk in that, but at the time i was so terrified and desperate that I did it anyway. I'm very lucky to have not experienced adverse effects from quitting that way. Quitting Prozac on my own that way when I was 12 because I believed I was cured and I was fine caused a huge spiral that lasted months at minimum. Please DO NOT discontinue medications on your own!!!!
Thank you if you've read this. Sorry it's so long.
TDLR: 2 months or so into Zoloft treatment I dealt with extremely heavy and worsening brain fog to the point of being almost completely unable to keep up day to day conversations.

I have been on Wellbutrin for almost a full decade. I am on the lowest dosage (100mg) simply as maintenance at this point, and it feels like a “security blankie” if that makes sense.
I am wondering if the Wellbutrin and Lithium are counteracting each other. I am on very low doses of each, but my body is extremely sensitive to meds, and I don’t need much to get an effect.
I have asked my psychiatrist about stopping both since they seem to be “at odds” with each other. Of course I am also terrified but wondering if anyone has this experience.
The reasons why include: I’m on another med (Lamictal) and I am experiencing side effects. I feel like my life has been taken over by psych meds. Thanks!

I acknowledge that any comment doesn’t substitute a medical professional, psychiatrist, or health-care personnel; I’m not looking for medical advice here but more of a personal experience; based on your experience, what's a good drug that addresses hypomania? I'm a medical student, and I find the racing thoughts to be really annoying and distracting. I have had it since I was 18 years old, and now I'm 30 years old. I have been treated for depression, anxiety, and ADHD. But my racing thoughts are consistent, and they are random, not necessarily anxious. So, when I looked at the DSM, I found that I meet the criteria for ADHD, Social Anxiety, and Cyclothymia. I've always been an A student. But when I was 18, I was under stress to perform high to get a scholarship, and I was crying almost every day. However, my academic performance was very high, and I didn't have problems with studying and enjoyed it. Then, before the finals, when I started studying for the exam, I started having this racing thought. I could not memorize things like before (I used to have a perfect memory of learning the material words to words), but while preparing for the finals, I started feeling that I was not retaining what I was reading. I go back over and over to read it, and sometimes, I feel like I'm not recognizing what I'm reading (like an aphasia). My personality changed overall; I became socially sensitive, not happy, and Impulsive. Studying becomes very stressful for me, and to be able to study, I have to read very fast or move my finger excessively on the touch mouse the whole time studying. Also, I developed hypersexuality, and I got into a few troubles. I felt the psychiatrist was missing something, and then I read about cyclothymia, and I think it made sense to me.
My goal is to have a calm mind and, at the same time, be able to study and function normally without being sedated. I think if I get a medication with a low profile of side effects, especially metabolic side effects, sedative, and extrapyramidal side effects for extended maintenance, I will be thankful. I take Lamictal 150, Escitalopram 10mg, and Adderall 20mg. I know that Lamictal has been approved for maintenance treatment. However, my racing thoughts are still there, and I find them distracting and do not make me feel normal. I looked up a few RCT and metanalysis, and most of them concluded that Lamictal is not adequate for hypomania/mania. So I was thinking if I add a medication that addresses that aspect, I will be able to feel normal like I was before I started having this problem. Based on your personal experience or If someone might know if there is something else other than hypomania/ mania that is causing these racing thoughts (Also, I wanted to clarify that these racing thought I had these before using any medication to exclude drug-induced hypomania/mania)

I (f, 28, Canada) am living with my parents due to being in college to be a vet tech. I am restless, irritated, easily angered, and want to do a million things but have no energy. My sleep is very agitated and not refreshing. I also have a lot of plans on how I want my life to be, but I have no energy. I try to put things into place but go back to my old ways. I know habits don't form overnight. I deal with ADHD and Bipolar. The idea of consistency feels foreign because both disorders thrive on it but are difficult to achieve.
I ruminate a lot and get anxious about the future. I often tend to dissect everything about an interaction with people and imagine what I could have done differently or what I could do to address perceived or real issues.
However, when I feel better, I manage to do more.
All the while, even when I feel bad, I somewhat manage to show up, I guess, but it's still incredibly difficult. I also tend to doom scroll and buy unnecessary shit and get dopamine out of it.
I'm in therapy. I pushed to see a pdoc saying my situation is pressing because it is, I suffer with passive suicidal ideations despite wanting to live. I'm on meds.
My life is going well actually, but I still can't manage to feel better. It has improved since being in therapy and on meds. I try to be kind to myself.
This is hell.
I guess whenever I feel good, I fear it's another episode and not just me feeling good. It's the same when feeling down. I fear I am spiralling into depression. I have become very aware of my hypomanic and depressive behaviours and cognitive dissonances. However, I still can't trust myself.
Plus, I feel extremely flat, kind of like the hypomania is controlled, and all I am left with is feeling down. I don't know if it's just me not being used to this feeling, but I hate only feeling down with some good times in between and a desire to live despite feeling bad.
My employer loves me. My family and friends love me. I have issues maintening my living space and getting the good grades that I used to have.
I'm on Lamictal 200mg, Effexor 300mg, Vyvanse 50mg, Seroquel 25mg and Dexedrine 5mg. Seroquel and Dexedrine are for my sleep.

My psychiatrist wants me to try rexulti because abilify side effects of binge eating. I see it’s only approved for depression and schizophrenia not bipolar despite the two drugs being similar. Right now I’m on lamictal which is better for bipolar depression maintenance but. doesn’t works as well for the highs and I’m bipolar 1. I’m concerned I will go back to hypomania/mania especially once the spring comes around which appears to be a trigger for me. He says at higher doses it treats mania but I haven’t seen that in the studies and it can induce mania instead. Does anyone on this medication have success with it treating manic symptoms?

Right now I’m in a depressive episode that will no doubt last five more months (woo, seasonal affective disorder), and I recently started to make the switch from lithium (useless poison) to Lamictal. I think the doctor plans to up the dose once every month, and I kinda want him to speed it up, but if the titration is slow, there is a lower chance of me getting The Rash, and the side effects will not be that bad.
Right now I’m on 25mg and will probably be at 50mg next week, though I’m not sure.
I hear that Lamictal is more of a maintenance drug, so I’m not very optimistic of it helping my current depressive episode, but it would be cool if it did.

Bonjour à tous
J'ai été "diagnostiquée" bipolaire ou cyclothymique par plusieurs professionnels de santé dont ma psychiatre actuelle, mais elle n'est pas sure. En attendant je suis quand même sous traitement (j'ai eu abilify et maintenant lamictal). Mais je ne me reconnait pas vraiment dans les symptômes des troubles bipolaires. Je suis en dépression depuis mes 9 ans et je n'ai jamais vraiment eu d'épisode maniaque, seulement des phases (environ 4 ou 5 ces 10 dernières années) ou je me sens mieux, ou j'ai plus d'énergie. La chose la plus "folle" que j'ai faite durant ces épisodes c'est de me mette au sport lol, aucune dépense excessive, pas impulsivité, pas de libido exacerbée, pas de sur-confiance en moi, ni de comportement vraiment anormal (parfois je vais avoir des idées un peu loufoques comme partir vivre dans un autre pays ou reprendre des études dans un domaine peu commun, on est d'accord que c'est pas très fou, mais je n'agit pas sur ces pensées et elles partent d'elles même).
Par contre j'ai beaucoup d'anxiété généralisée et des phases de dépression intense ainsi que de l'alexithymie. ça me parait vraiment léger pour un diagnostic de trouble bipolaire y a t-il d'autres personnes qui ont une forme légère de bipolarité ou je devrais m'orienter vers d'autres diagnostics ?
Merci et bon courage à tous :)

Hello everyone - I hope everyone is having a lovely day so far.
I restarted some of my psychiatric medications around two weeks ago following a complete cessation of administration due to my prior drug regimen inducing serotonin syndrome, for which I was briefly hospitalized.
Following medication stoppage, my bipolar II symptoms came roaring back, and I subsequently restarted two of the prior medications I was taking.
These events have led me to reflect on my journey with prescription medications for the treatment of Bipolar disorder, as well as other mental health issues that my psychiatric nurse practitioner prescribed and recommended medication for.
Prescription medications taken prior to Bipolar II diagnosis:
Escitalopram - 20 mg for about a year (for what was thought to be for depression)
Bupropion XL 150 mg for four days (also for depression; instead, medication triggered first episode of dysphoric hypomania, leading to Bipolar diagnosis)
Prescription medications taken since Bipolar II diagnosis:
Lithium Carbonate - 150 mg twice a day, used for a couple weeks at a time in and off for first year of diagnosis.
Lithium Carbonate ER - 450 mg twice a day, used as needed for acute dysphoric hypomania and immediate suicidal ideation. (Hasn't been used for this purpose for at least a couple years)
First successful drug cocktail (regimen):
Lamotrigine - 200 mg once a day for mood stabilization
Fluvoxamine - 300 mg split over two doses throughout the day for obsessive compulsive disorder and anxiety/latent depression
Quetiapine - 300 mg once nightly for manic depression and dysphoric hypomania
This cocktail was used successfully for about a year, until quetiapine had to be ceased due to weight gain.
My PNP and myself worked though a host of medications in order to seek a replacement, and much trial and error was undertaken.
Medications that were substituted for quetiapine include:
Oxcarbazapine - anticonvulsant mood stabilizer (stopped due to itchy rashes appearing on body)
Atypical Antipsychotics:
Aripiprazole
Lurasidone
Cariprazine
Finally, we arrived on Lumateperone, which has not had significant side effects, or at least any that I notice. Therefore, I kept taking lamotrigine and fluvoxamine, and ultimately replaced quetiapine with lumateperone.
This cocktail was working, and soon Adderall was added to address ADHD. I think it is here where mistakes were made. Based on discussions with my PNP, as well as information from drug interaction checkers, it appears that the combination of Adderall and Fluvoxamine enhanced each others' serotonergic effects, inducing serotonin syndrome.
Following my hospitalization, I have restarted both lamotrigine and lumateperone, and currently at 50mg and 42 mg respectively.
I have also replaced fluvoxamine with sertraline for my OCD; hopefully, I will experience less interaction risk with this SSRI.
So, current cocktail as of today is as follows:
Lamotrigine (Lamictal) - 50 mg daily for mood stabilization (aiming to be on 200 mg maintenance dose)
Lumateperone (Caplyta) - 42 mg daily for manic depression and dysphoric hypomania
Sertraline (Zoloft) - 25 mg daily for OCD/anxiety and latent depression (aiming for at least 200 mg maintenance dose)
N-acetylcysteine (NAC) - 600 mg daily for OCD
Propranolol - 40 mg as needed for anxiety
The adderall was did appear too effectively treat my ADHD, so it is a little disappointing to no longer have this tool in my kit, but alas.
In finality: This is my present drug history and cocktail used to treat my mental health conditions.
What prescription medications have you used in the past for treatment, and what is your present drug "cocktail" you use currently to keep your symptoms in remission?

Yes, you read the title right, my parents went to court to get ECT treatment for me when I was 14. For context I’m now 20 and stopped ECT before college. I live in the US and received ECT at Mercy and Barnes Jewish Hospital in St. Louis, Missouri. I have anxiety, major depression, OCD, BPD, anorexia nervosa, and C-PTSD (from all the hospitals and centers btw).
I developed severe OCD when I was 8 years old. When my parents found out I was also SH when I was 12 I finally got therapy. I started medications at my first hospital visit. After discharged I was admitted again 48 hours later. This started the cycle of hospitalizations, meds, residential treatments, etc.
We started ECT after 12 hospitalizations when I was 14. At this point we had tried many antipsychotics and antidepressants. But there was a specific reason that ECT was chosen for me after treatment resistant depression and cluster b symptoms. I have drug induced QT prolongation. Prolonged QT can only be seen on an EKG and there are no symptoms. If it gets high enough, you will drop dead without warning. This meant that a huge amount of medications were not an option for me. I even had to stop medications that helped because of my heart.
I first had 12 rounds, bilateral 10%, 3x per week. There was an immediate change. It decreased depressive episodes and also let my brain see that the depressive episodes never lasted forever.
I started doing maintenance ECT from 16 to 18. Overall I’ve had about 65 treatments total. Many were done during hospitalizations and treatment stays for my anorexia. As of now I haven’t been in psych for about 16 months which is my record since being first admitted 8 years ago.
I had short term memory loss such as forgetting tv shows and family vacations. I have long term memory loss but that is related to my PTSD and dissociative amnesia. Aka my brains way of protecting myself from trauma.
I’ve never been off meds and today at 20 I’m on trazidone, Wellbutrin, Cymbalta, Lamictal, and gabapentin for the MH stuff.

I am already fighting so hard against my own brain most of the time, and I'm so frustrated with the care my work-connected insurance allows me access to.
I know I'm probably in the minority here, but I looooved Kaiser mental health. My psychiatrist there was wonderful and listened to me. We had a long relationship over several years, and she helped me with medication management to feel fully stabilized with Bipolar I, anxiety, and ADHD. I was taking 300 mg Lamictal, 10 mg Abilify, up to .5 mg of Klonopin as needed (which I really did take as needed, no issues with abuse,) and 36 mg of Concerta as needed (ditto on that one.) She also diagnosed me with anxiety, changed my diagnosis from BPII to BPI, and was on the team that diagnosed my ADHD (long overdue honestly but no one ever caught that before.) I saw her for most of my 20s and I had some great years of stability and growth as a person.
And I'm sitting here crying about who I was able to be then because I lost that insurance when I lost my job at one point, and now I have different insurance and have been desperately trying to get back to that place. I have been unmedicated and/or undermedicated, doubted that I have the diagnoses I do, and I'm so exhausted about it.
Most don't want to prescribe controlled substances, or think the Concerta is too dangerous to use for a Bipolar person. I have constant anxiety and I'm currently giving a handful of new meds a try to see if I can take something daily instead of taking an infrequent small dose of Klonopin that staves off the attack. I feel like if I argue it's seen as drug seeking, but I hate having to take all these things that don't work as well or at all or give me side effects, when I KNOW a treatment works.
I get constant back and forth from each new doctor about if it's BPI or II, if I've really experienced mania, if I even HAVE bipolar because I'm not currently having a bad episode, if I actually have ANY of my diagnoses and it isn't actually PTSD trauma from my mom (that was a weird one, like it's not???), just on and on.
Do most pdocs just feel like they aren't really working if they don't create a brand new treatment plan with brand new diagnoses or something? Even now I have finally found a psychiatric RN who is the best I have encountered. He takes my insurance and was taking on new patients, so that already made him better than 95% of people I called up. He has me back on Lamictal, which I'm impatiently patiently titrating, and Abilify. He's willing to add Concerta when I'm not in a pretty severe, long mixed episode, and that's fine. He said he is willing to prescribe benzos but wants me to try a couple other rxes first. Okay I guess. He's nice to me, is only a little late to every meeting (later than I could be without incurring a missed appointment fee, but yknow), and the copay is actually way cheaper than meeting with a psychiatrist.
But then we were discussing my maintenance dose of 300 mg Lamictal and he said he doesn't like to prescribe more than 200 mg because of studies that show 200 mg is enough. And I understand, but why is my past, years-long experience with both dosages not important? I am articulate and able to report my symptoms, have a background in general science and psychology, and have a ton of experience with my own mental health, and even I can't get the average pdoc to recognize my agency here.
Bipolar and comorbidities are hard. So hard. Why does receiving care feel like it makes it even harder?

Does anyone manage to function on just a small maintenance dose of Lamictal (say 50-75mg - monotherapy) ? I'd be eager to read your experiences and learn how you got there. Thanks for your input ! ☺️

100mg Seroquel 50mg Lamictal 20mg Lexapro
I'm new to this disorder and had my first manic episode (lasted months) and now a major depressive episode.
My psych (nurse practitioner) thinks this will be a good maintenance dose, but from everything I'm reading it wouldn't be. I'm all for low doses but this doesn't seem right. The whole time I was manic she only had me on 50mg Seroquel only as well.
Any thoughts?