Headaches, Sweats, Tiredness,...& Meds
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Q:  Headaches, Sweats, Tiredness,...& Meds

Dear Doc.
I have been put on lamictin 150mg and zoloft 100mg daily for anxity and a mood stabilizer. I have been on this coctail now for 4 months, and the last 2 weeks my vision has been affected, I have head aches, hot sweats,tiredness and feeling very lazy, at night unable to sleep but during the day could sleep, I also take adco- olpidem to help sleep re back pain 15mg. Can I also add that I do have a bad back and would give anything for South Africa to operate and give me a new disc(opetation not available here), mine is L4 L5, unable to have fusion they say, so I also take cataflan and voltaren for pain. My weight has shot up, which again does not help my back, could the above systoms be the tablets. If I was my horse (which, mine I can longer ride) I would have her put down, some days are very bad for me and I feel unable to cope, what is your opinion?

Dear Louise -- 
Sorry, I couldn't identify "adco-olpidem" (e.g. Google search) so I'm not sure what you're taking there (sounds like zolpidem, which is Ambien in the U.S., a medication for sleep).  

Well, there are a lot of parts to this story.  Sorry to hear you can't ride, what a disappointment.  It could be that the back pain is the central problem, interfering with sustained sleep, which can make bipolar disorder worse. 

But then again, so can antidepressants, and you're on one of those.  Sometimes I feel like a broken record, just repeating "watch out for antidepressants"; but here we go again.  Ask your doctor if she/he thinks your antidepressant could be making your bipolar disorder control worse, which could mess up your sleep cycle, which can make back pain worse, which can make bipolar disorder worse, and so forth.  

In other words, "it could be your back"; or, "it could be your antidepressant".  Or it could easily be neither, including, for example, that your bipolar disorder is not sufficiently well controlled regardless of the antidepressant, which might not be contributing to the problem and could end up being an essential ingredient (I have to say that to show that I can acknowledge this is possible, even though in my experience it isn't true very often).  In this case you'd have to think about another mood stabilizer to add to the lamotrigine. 

Obviously what I wanted to emphasize is that you might have a part of the solution to all this that's a lot simpler than surgery; or even adding another medication; namely, gradually tapering one off, the Zoloft, and replacing it if necessary with either a higher lamotrigine dose (up to 400 is routine, 200 is often better than 150 but you have to get there carefully under your doctor's supervision as there's risk in going up too fast; and lamotrigine even has anti-pain properties itself that might be stronger at a higher dose) or an additional antidepressant-like mood stabilizer (low-dose lithium, and perhaps omega-3 fatty acids, are the candidates there, as you'll see from that link above).  

If that actually works, and you get back on that horse, which should be the goal (including adopting some other form of exercise that you can do, to lower weight, in the interim), write and let me know. 

Dr. Phelps

Published May, 2004


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