Suggest Treatment For Lethargy And Diarrhea While On Lamictal

Posted on Thu, 1 Dec 2016

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 1 Dec 2016 Answered on

Wed, 21 Dec 2016 Last reviewed on

Question : My 19 year old son has been diagnosed with bipolar 2, anxiety, and depression. In July e was arrested for marijuana possession which he was using to self-treat his feelings of being very sad. He spent six weeks in a recovery program and it was there that he was diagnosed. He has been taking Lamictal 100 mg bid and Zoloft 200 mg once a day since August. He continued to have depression and difficulty concentrating so the psychiatrist prescribed Adderall (5mg then 10 then 15 then 20 mg) twice a day. The doctor has stopped the Adderall. He has now added Latuda 20 mg once daily which my son has now taken for eleven days. My son tells me he has "felt this medication building up in his system" and has experienced side effects...diarrhea, need to lie down. Yesterday he seemed fine...went to class then later to work (4-10:00 p.m.). A co-worker drove him home from work because he felt "really sick.' He was extremely pale. His forehead was covered with beads of sweat. He could barely walk or stand or complete a sentence. He had great difficulty swallowing. All night he was restless with frequent awakening and a LOUD "snoring" though he was breathing through his nose not mouth. He would open his eyes and shake his head from time to time. He did not want me to leave his side. He called out to me throughout the night to make sure I was still there. He was very thirsty but could not take more than a sip of water at a time. He mumbled throughout the night ...almost like he was talking in his sleep. He mentioned that he thinks the Latuda side effects are getting worse and worse. My son has an appointment with another psychiatrist in a couple of weeks for a second opinion. My son remains very tired...groggy...sleepy this morning and is resting. Ath this point I am afraid to allow him to drive, etc. He is very fearful of the terrible depression he has had in the past and reports that he has been depressed for at least the past four years. Do you have any advice as to how to help my son?

Answered by Dr. Dr. Ashok Kumar Choudhary (54 minutes later)

Brief Answer:
I think Latuda need to be stopped

Detailed Answer:
Hello,
Thanks for using Healthacnremagic.

I read your post with keen interest and understand your concerns.

First of all I feel there was rational use of lamictal and zoloft but I do not see a significant rational for prescription of Latuda. Yes this is a medicine good for bipolar depression but there is no indication that it should be used with lamotrigine.

The gastrointestinal side effects are most pronounced with latuda and it is possible that he will not able to tolerate the therapeutic dose of looted for bipolar depression (it is 40-120 mg per day). I opine this because he is not able to tolerate 20 mg itself and possibility of higher dosage is almost nil.

So in my opinion Latuda should be stopped at first hand.

Second definitely you need to remain by his side and take care of his needs. He should not be left alone. Thirdly you are right not to allow him to drive. As I said somebody should accompany him and that includes commuting to school.

For the further management I feel seroquel should be considered for further treatment. Discuss the option of withdrawing lamictal and add seroquel to his prescription.

I hope this assists you.
If you have any further query, I would be glad to help you.
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Thanks and regards.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar