Q: Lamictal & Sexual Function
I have a possible soft BP diagnosis. I've discussed this with both my
therapist and psychiatrist and the verdict is unclear. Based on family
history, anxiety and recurrent dysthymia seem more likely. Regardless of the
the DX, I started Lamictal a few weeks ago. I reacted pretty badly to the
starting dose of 12.5 mg/day: tiredness, increased agitation, then eventually
a levelling out in mood, possibly a little above where I started.
Both when I started at 12.5 mg/day and when increasing to 25 mg/day I got some
pretty intense aches in my lower back and groin. They subsided in each case,
to a large extent. but some achiness and tightness seems to remain. But they
seem to remain, waxing and waning in intensity.
The ache/tightness in my groin is the more troublesome, since I believe it to
be associated with some loss of sexual function. Basically, it feels as
if my prostate is being somehow pinched, which interferes with my erectile
function. (I'm male, obviously.)
I am wondering if you have heard of this sort of a reaction before. I do think
it is associated with the Lamictal, since there were no other significant
changes to my lifestyle and medication/supplement regimen over that time. Is
this something that is likely to subside over time? Or, have you expereinced
patients who respond with lower back/groin pain for whom it never goes away?
Also, I attempted to go up to 50 mg/day a few weeks ago, which turned out
to be a very bad experience. One day of tiredness. Then a day of what I can
only describe as "hypomania": too much energy, agitation, constant and
unfocussed thinking (almost racing). This makes me think that my "up" periods
in the past might not have been genuine hypomania, since they seem much calmer
in retrospective comparison. (Rather, they might correspond to reductions in
my self-critical anxiety, which is the predominant feature of my mental
The following two days I experienced increasing anxiety (and concomitant
tiredness), culminating with a (clinical) panic attack. I will grant that
there were other stressors involved, but I feel as if the Lamictal
fundamentally destabilized me. I reduced my dose back to 25 mg, and added
Xanax to settle me down. I am still at 25 mg, and scared to
attempt a dose re-increase. I also feel that Lamictal might not be the
medication for me, due to the aches and sexual dysfunction, as well as the
fact that I might only fall vaguely within the penumbra of the BP spectrum.
But, I would be very interesting in hearing your thoughts on these reactions.
E.g., are they something that you have seen in other patients? Are they likely
to be transient?
Any information is greatly appreciated.
Dear Henry --
Just yesterday I had my first patient on lamotrigine ask whether his sexual
function problems might be due to that medication (or another one he is
taking). I may not screen well enough for such problems, but I can tell you I
don't hear about this at all with lamotrigine; it made this patient yesterday
stand out. I called the company rep' to see if he hears much about such
problems; he says no (though obviously he has some stake in believing and
reporting the answer to be no).
However, I have had a very few patients get what looked
like some sort of overstimulation effect on lamotrigine. It looked pretty much
like what antidepressants do in people with bipolar disorder, and rather like
what you describe, including causing panic attacks. I've never been absolutely
certain the lamotrigine did it; and I've never had a patient who was in a
position were we just had to try it again (actually, I've had a couple such
folks, but when they tried it again, they tolerated it fine and found it
helpful, so perhaps it wasn't the lamotrigine in the first place, for them).
But I do think lamotrigine can do this, although very uncommonly.
Lamotrigine also has caused bone/joint pain in a few of
my patients, and that side effect is on the list of adverse effects of the
medication (I know that one, had to go look it up at the time). That might
account for some of the back pain, perhaps.
Published July, 2005