Lamictal & Somnolence
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Q:  Lamictal & Somnolence

My 18-y.o. daughter, diagnosed with Bi-polar II appears to have been helped considerably with lamictal- but she's still sleeping way too much and constantly complains that she's tired, and insists she's not depressed, she't tired.  I'm pretty sure that one of the side effects of lamictal is somnolence--is there anything that can be done?  How do we tell if it is the medicine that's making her so tired?  It is not a minor problem as her doctor seems to think, because it's similar to depression, if you're in bed all the time and not engaging in your life.  She takes 1 lamictal in a.m. and 2 in p.m., 25 mg. she is 5'7" and 120 lbs., pretty thin--does weight affect dosage she should be taking?  she offsets it with adderal, but that seems to help only so much.  Thank you.

Dear Ms. H. --
Tiredness is not a common problem on lamotrigine (Lamictal). Sometimes a very high doses, like 300 or 400 mg and an adult, there is a slight slowness which is -- in my experience -- nearly always accompanied by a mental slowness and some odd problems with finding words and finding people's names.

So tiredness really does not fit, especially at this dose. That means opening up the question of what else might account for this. I think most doctors would think the first place to go is "check thyroid". If your daughter is particularly overweight, another might be "sleep apnea", particularly if she has that kind of snoring (crescendo, with minor awakenings in between episodes).

Beyond that, tiredness and sometimes be a symptom of bipolar depression even without the Depression. I know that sounds odd. But just as energy can go up without euphoria, in versions of mania, manifesting instead as agitation or anxiety and difficulty concentrating -- so too can energy go down without mood. For a reference on this, in which the separate cycling of mood and energy is described in detail, here is a summary of an article on that topic:
Rapid Cycling As Waves.

If the tiredness "comes and goes" to any degree, suggesting continued "cycling", particularly if this is accompanied by changes in sleep (e.g. more sleep during the "tired" phases), then any of the mood stabilizers might potentially alleviate and then prevent return of this tiredness sometime. However, if there is no suggestion of cycling, this strategy may not be as relevant. In that case, I think inviting a primary care physician to investigate other potential causes of constant tiredness might be a good place to start. That might be warranted anyway, but I hope I have added a couple of ideas to be considered as well.

 Dr. Phelps

Published November, 2007


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