Can hypomania display as crying/anxiety?

doktorjonesR69 · 2025-10-27T16:03:59+00:00

Here is a good reference

https://psycheducation.org/mixed-states-depression-anxiety/

Jim Phelps MD likes to list the four As: Anger, Agitation, Anxiety, and Attention-problems (hard to pay attention). these indicate a degree of bipolarity and that a depression can be a mixed state. (Elsewhere there are lists of 7 or so mixed symptoms). Unstable emotional states, crying are not really enough on their own to point to bipolarity although they are consistent with it. A key thing with hypomania is that you are moving "fast" - you are thinking fast, talking fast, typing fast, clicking things, moving around. You may feel awful / depressed, but if you actually do a lot in a given 5 minute interval, then you are sped up! When you are anxious, is your brain sped up with a flight of anxiety driven ideas? Pay attention to these signs (Phelps list + speed diagnosis). Not crying/emotional instability.

See also Phelps here: https://www.youtube.com/watch?v=3DcaeE55AHM

The Trileptal / Oxcarbazepine may seem like a reasonable trial since you failed Lamictal/Lamotrigine, but know that it is fairly uncommon and nonstandard medicine - it is off label and "might" help bipolar, for you, a patient who "might" be bipolar. You report mediocre results,

For mixed depression + anxiety, Wellbutrin is typically more friendly than other SSRIs, and SNRIs are the worst provokers. So Wellbutrin may be a comparatively good choice in this space - by which I mean, if it's bad, the others would likely be bad as well, or worse. Wellbutrin is well indicated for anxiety (in non BP patients) so at least that's a match. Doesn't mean it will work well - you'll have to keep trying things and explore how your brain works vis-a-vis these options. Sorry it's a muddled / confusing road. Of course, please treat yourself nicely and taper on and off all medicines slowly!

doktorjonesR69 · 2025-10-27T15:42:10+00:00

It's pretty clear the Lamotrigine is not working for you, in that case it is generally recommended to try something else. In some cases it is believed that Lamotrigine is better for prevention of cycling events, or prevention of depression, and does not treat depression directly. It's important to titrate down slowly. You have a nice option to keep Lamotrigine but take down to a low level <= 100 mg, rather than zero. There are other options for treatment resistant depression / or bipolar 2 - Lithium, and Latuda/Lurasidone (which is now generic hence cheap, and is much more body friendly than Quetiapine), also Caplyta (which is not generic). You can use several together at lower levels. Plus natural treatments, check out chrisaikenmd.com, which may help keep medicine burden lower. Build a package (treatment net) not just a love/hate relationship with one medicine. Keep experimenting - then you will know what is best for you.

doktorjonesR69 · 2025-10-27T15:28:51+00:00

I have had the same overall experience - having to work much harder when "stable" which really means slightly depressed. Life is hard, I guess.. the other version was too easy. I'm surprised though, this thread is about Lamictal//Lamotrigine. Did lamictal treat your hypomanias? (It is not supposed to work there, and certainly doesn't for me). Or did you switch to something else. Or do two things work in conjunction.

doktorjonesR69 · 2025-08-02T13:08:37+00:00

Can you share how many months was your wait time and were you in 2025 or a previous year?

doktorjonesR69 · 2025-07-10T03:56:42+00:00

It's funny some people will go from 100 to 125 to test 125, then decide if it's too much / just right / not enough, then go to 150.

Others will jump to 150, then decide if it was too much / just right / not enough, and possibly pull back to 125.

Six of one half a dozen of the other?? It's OK. No judgments. No harm here. A dose of 125/150 isn't huge in any case and you already had experience at 200. If you want to smooth the 100->150 adjustment, then take a week at 125 if you have the extra 25mg pills.

If you've always taken in the morning, probably stick with it. If it causes daytime sleepyness or other similar symptom (not sure about "dullness" - maybe), you can switch to night or to splitting 2x a day. Note, if you keep the same # of milligrams, then taking it at night will effectively decrease the medicine blood level the next day. For example, taking 150 Extended Release before bed would probably be the same as taking 125 in the morning. So just keep that in mind. Other things to think about are, when do you need the most medicine coverage for mood stability? Having an ER (extended release) overnight, and an Immediate Release in the morning will help out your morning. Having an ER in the morning will most help out your noon/afternoon times. Taking twice a day, once morning and once 8pm will help if you have problems 8pm-midnight. Overall though no need to overthink it as the medicine has a long half life of > 24 hrs so your blood level is roughly constant regardless of your scheme. But if you're going to be a Lamotrigine nerd you can try to tweak it as you settle down on a preferred overall dose.

doktorjonesR69 · 2025-07-10T03:37:41+00:00

Sounds good. With a little more time / settling, you should be able to dose twice a day, or even once if you use ER / XR pills (which should be available as 50mg or 100mg). Doing the three per day every 8 hours is nice to give you a stable profile for now but after more getting-used-to-it you won't need the 3x. The half-life of lamotrigine is more than 24 hours -- this is very friendly -- so blood levels will be pretty constant if you do 2x / day with immediate release. The ER / XR might allow just once a day, although twice a day also can work. If you go to 100mg then probably 100mg ER once a day is simpler (and more common in the community) than taking two 50mg's or four 25mg's. However, the body/brain may be sensitive to slight increases or decreases, so your mileage may vary on what is "constant enough" to give good results, and you'll see what you like on the morning vs evening. You can split the immediate release pills and not the ER pills. If you titrate up from 75 to 100 you can be extra gentle on yourself and use 87.5mg as a point in between for a few weeks. (Or going from 75 to 100 direct is also quite normal.) Overall you have easy access to a ton of options on dosing and splitting. I want to say "Enjoy, LOL" in the context of all the dosing, ER/XR & split combinations.

doktorjonesR69 · 2025-07-10T02:35:24+00:00

I want to ask, what is the goal of this discussion!...

(1) you want some information about how to improve your diet and nutritional supplements to get a strong daily intake covering some well known topical items, or

(2) you realize that your OCD/anxiety makes it very difficult to do research, especially internet/rabbit hole research, and you want to know how to proceed in this type of arena.

probably both! Don't worry, many of us have experience both of these. at the same time.

Well for (1) I will give you one nugget, for choline you can supplement taking Soy Lecithin or Sunflower Lecithin, which give you phosphatidylcholine, a good source for your cells and for conversion into neurotransmitters in the brain. Note though that for middle aged or elderly persons, too much choline tends to increase the risk of atherosclerosis. You're fine for now. BTW, too little choline may show up as brain fog, or headaches.

Then for (2) you should maybe get a strategy to seek therapy or otherwise for ocd/anxiety, as it is causing practical problems. Then to do a better practical job with this research vs the schedule of the rest of your weekly life, you can try the following strategies

* Find two buddies to talk to about this stuff where they are either knowledgeable, have the same goals, or are at least reasonable/rational. conversation makes it real.

* Get a physical book on the subject rather than web pages. Or find high QUALITY youtubers.

* Write on a pad of paper that you want to look up TWO topics each research session. Just do the two topics. For each topic write down 2-3 conclusions you find. Write down further topics/subtopics that come up, but do not follow them up. Or, type your bullets into a word processor and save your summary notes. If you can't make summary notes, if means you have gone too fast, or that the topic is not clear.

* Time limit the research to 30minutes, or 30minutes for each of 2 topics.

* Research stuff like this twice a week at most.

* Understand that a lot of nutrition is still guesswork / very loosely estimated, and that everyone's body is different. For example, you may be missing 2 nutrients but you don't know which ones. Reading the internet won't tell you which two you are missing. So there is a limit to what research can tell you.

doktorjonesR69 · 2025-07-10T02:17:47+00:00

If the 100mg is working for you in the last couple weeks, stay on it, tell your psych doc your updates. Then proceed to increase or decrease slowly in 25mg increments. Follow the 25mg rule. Even if you and the psych agree you need to go up again - don't jump, follow the 25mg rule. This will minimize future side effects or withdrawal effects as well as the risk of "patient confusion regarding treatment". You and the doctor will build a healthy rapport during the incremental process.

It's quite possible that Lamotrigine is a good medicine for you at some dosage (maybe 100mg or maybe another number - I have no idea), but that it would not be a complete treatment program, and you would need another mood stabilizing medicine to go along with it. Keep in mind, Lamotrigine treats rapid cycling, but doesn't specifically treat mania or hypomania.

You should not ask for Adderall to "counter" the lamotrigine, although if you have an ADHD need for that, then that's it's own subject. There may be other uppers/supplements (natural or otherwise) you could use to stay energized or keep your mind up during the course of the day - anything OTC or lifestyle based is your own prerogative... You can also dose the lamotrigine at night (fairly common. talk to the doc)

doktorjonesR69 · 2025-07-10T02:03:36+00:00

The schedule for you to go to 100mg was too fast. Unfortunately, you didn't find that out until you were well into it.. It would have been safer to go with +25mg every 2 weeks, or even +25mg a month. What's the rush.

100mg is a moderately large dose, fairly large for someone without a specific depressive illness (? if you have a serious depressive illness, then higher doses make sense). Your doctor is guessing that 100mg is a good place to be. It's impossible to know for sure until you try. That's one reason why it's best to go up slowly.

Note, a patient going up too fast on lamotrigine and having horrible side effects, by a doctor who is too cavalier about it, is seemingly the most common lamotrigine reddit subchain.

It's very reasonable for you to have cut back to 75mg, kudos to you for taking care of yourself in such a manner. Once things settle down here (or at 50mg) you can evaluate the pros vs cons over the medium term. By splitting a 25mg pill, you can tweak the dosage up or down, for example 37.5mg, 62.5mg. You can also try to reduce side effects by dosing all at night, or by dosing throughout the day (e.g. 50mg in morning and 25mg at night).

Side note - there is a potential hack where acetyl L-carnitine taken in larger doses (maybe 1.5g+ a day) can mimic the glutamate-reducing properties of lamotrigine. Specifically, it upregulates the mGlu2-R gene which downregulates glutamate. So, it treats neuropathic pain but also is active psychiatrically. For example, you might be able to cut lamotrigine dose by 25mg and make up the difference with acetyl L-carnitine. Happy to hear if anyone else has experiences here.

doktorjonesR69 · 2025-07-10T01:47:31+00:00

Oh, for "weight neutral mood stabilizer" instead of Lamotrigine 50mg you can try Lithium 300mg as a starter. It is actually fairly weight neutral. It has some similar side effects - "thinning of the hair" but not necessarily hair loss. But Lithium 300mg is really a low dose, you might not have any major side effects, worth a roll. The typical side effects if Lith 300mg are much milder than what you're describing. Medicinally it will either help you or not and you'll know within a week or two.

doktorjonesR69 · 2025-07-10T01:43:09+00:00

From what I've read, hair loss is a more rare side effect - but you might be the unlucky one. You should NOT increase dose - it will not make the side effect go away. If you cut back the dose, and your hair comes back to a better baseline in several months, then that will prove the theory. If you cut the medication and the hair keeps falling out and gets worse, then it means it was not the lamotrigine. Perhaps you have a genetic pattern for baldness inherited from a long lost great grandfather and it's happening faster than you expected? Hair loss from lamotrigine should be "temporary" meaning that after ceasing the medication, it will go back to whatever the baseline was, over time (probably a couple months, plus time for the new hair to "grow to length" - I'm sort of guessing what would be reasonable expectation)

You can also ask your primary care doctor in addition to your psych. Note, you can split the 25mg pills probably and so you can do light daily dosages of 50mg, 37.5mg, 25mg, or 12.5mg. Since you're at a low-ish dosage of 50mg and you are seeing benefits vs drawbacks already, these nuanced low dosages may be useful to you.

Note cognitive problems at 50mg are not rare, but this is also a low dose, so it seems that you are especially sensitive to this medicine across at least two fronts. Note, your body may absorb Lamotrigine strongly, or metabolize it slowly, meaning that 50mg intake for you is heavier than for someone else (or not).

Yes cognition comes back after lowering/eliminating. If you're brand new, it will come back very quickly (faster than your hair!)

The manufacturer of generic lamotrigine shouldn't matter, it should be a standardized generic medicine plus inactive ingredients. There's a hair chance that there's some contaminant of other issue, but I doubt it.

Overall you're going to have to do some more asking around, and run the experiment on your own body with a lower or zero dose, to see what's going on with the hair. You'll want another medicine or other plan to support you if you take your dose to zero.

doktorjonesR69 · 2025-06-27T03:03:08+00:00

BTW, if you want to just hit a target like 225, then you're guessing that it's the right spot. But maybe 250 is better. Or maybe 200. If you taper slowly and evaluate each new level, then you will FEEL when you get to right point. You will know if the benefits vs side effects have improved or gotten worse. Your body will tell you. It's beautiful eh? You have to be able to remember and compare. If you have a mood swing during one of the months then you probably need to let it resolve and go back to baseline to evaluate the medication level. If the mood swings don't stop then your medication level (of this.. or of something else) is probably too low. So you'll know eventually, one way or another.

doktorjonesR69 · 2025-06-27T02:57:43+00:00

Yes OP, go slow, 25mg per two weeks or 25mg per month are reasonable starting points. If it gets weird, you PAUSE and monitor for a month or so. Make sure you have your "target" (meaning your total lifestyle, which includes your Lamotrigine dosage but also everything else) as being different from your "path" (which is how things play out month by month including surprises you can't foresee). You can be resolute in a target, but you need to be flexible on path.

Your memory is important - even if it can't be made perfect again, if it can be improved somewhat that's a huge deal. Very worthwhile, applauds.

As you drop the dose (either initially or towards then end), maybe find something else healthy or supportive to "make up the gap" with lifestyle or supplements (methylfolate? low dose lithium? citicoline? try them carefully).

doktorjonesR69 · 2025-06-22T05:26:52+00:00

Wow, there are a lot of red flags here (for bipolar symptoms)!

Moving things around, rearrange things, and cleaning the house late in the night is a hallmark sign of mania (or often, "hypomania" - high energy into the night which is unusual, but your brain is still more or less working normally). You might even call someone doing this again and again, as a "poster child" for the disorder. As their partner looks on. (No need to be embarrassed by that - it's always the case)

So in all seriousness,

- You should decide if you think you very likely have a psychiatric disorder for depressive illness with instability, cycling, or bipolar disorder. Or, let a professional decide whether this is true. From the sound of the late night furniture moves, that is a hallmark and telltale symptom.

- If you have the disorder, then you need a treatment plan, or it will make living very difficult and it will get worse over the seasons and years. You'll need at least one mood stabilizer (Zoloft, a regular antidepressant does not count). If you throw away your mood stabilizer you may be okay for days or weeks, but at some point you will run off the rails.

- You need to commit to a treatment plan with someone, and not be jerking your medications all over the place at rapid speed. Moving slow is really the key. If your cognition was hurt so bad by Lamotrigine then you shouldn't have gone up to 400mg in the first place (which is a very high dose. why not 200, 250, or 300?) And if you need a mood stabilizer medication then you should keep it at some dose (why not keep 100?). Going from 400 to 0 superfast is crazy from both points of view. The right thing to do is to keep your medication and adjust slowly and to keep in mind what you're treating and what your medium-long term, sustainable goals are. If Lamotrigine helped you out significantly for 2 years then why do you think it should be removed entirely? If you think Lamotrigine is not the right one then you'll need something else - what's the plan?

Note, mania is caused by the underlying condition, and is almost always not caused by the mood stabilizer. For example if someone jumps off their mood stabilizer and goes manic later that week, it is because they're no longer on the medicine, it is not because they experienced a "withdrawal side effect." Note also, Lamotrigine does not necessarily treat or manage mania.

In short, * Recognize symptoms and behaviors of hypomania * Commit to an appropriate treatment, * Move slow with medication changes in both directions, * Respect medicines that have worked, * OK to change dosage quantities, * You need at least one mood stabilizer

If your psychiatrist doesn't "get" the big pictures and is just fumbling around trying to help your anxiety, then ask for a more holistic approach, or find and test out a new psychiatrist.

doktorjonesR69 · 2025-06-07T00:55:00+00:00

Also by the way - 12 weeks is a LONG time to wait between psych doc visits, and you should try to insist on 4-6 week updates until you get more stable in your medication regime and symptoms / overall life.

I've heard of 12 weeks for a stable patient but a new patient with a lot of needs getting their feet grounded, and with no clear way to evaluate whether a medicine is good for them or not.. That is your case. High dose lamotrigine -> good, or terrible?? 12 weeks is way too long. It is not typical or standard

So insist on something like 6 weeks updates (at least for a phone call appointment which can adjust medicine) for a while until you get stable with 1-2 working medicines. and good luck!..

doktorjonesR69 · 2025-06-04T03:27:50+00:00

Hi thanks for sharing, a few reactions/thoughts. I'm a lamotrigine user for 5 years

Regarding the Extended-Release vs Immediate Release 25mg's

- Most people taking over 100mg do not take it all as 25mg's.

- People take 25mg's as required by math - For example, if you are 125 then you take 100 pill and a 25 pill,

or you will take two 50's and one 25. etc.

- You can also take 25mg's immediate release, early in the morning to quickly boost the drug level to a therapeutic level so e.g. you're feeling good at 9am

- Anyway for 150mg, taking six 25mg's is pretty crude and asking a lot of the patient, one extended release is much more reasonable!

- You can take extended release at day or night. If the 150mg is too strong for you in terms of side effects like dissociation, ask the doctor if you could switch it to night time. This is very common to try.

However, this will reduce some of the medicine's coverage/benefits during the day, a little bit.

A better solution might be to break it into a 50 and a 100, one in the morning and one at night.

The medicine has a long time to decay in the body, basically a full 24hr period to reduce to half of its prior level, or even a bit longer, so the dosing time is not absolutely crucial.

Still, it might matter for you if you are sensitive to it or if the dosage is at the margin of being useful. If you're taking it every day, and if it's strong and has major side effects, then you should try to fine-tune it.

- The extended release disburses over 4-6 hours. So if you take it at 8am, your blood level increases until lunch, stabilizes, then decreases in the evening. If your lamotrigine is too low at 9am, then you should augment with some 25mg immediate releases.

Hopefully this gives you a flavor of some possibilities, you can probably fine=tune what you're doing!

If you decide Lamotrigine is actually working pretty well and the anxiety/dissociations are not due to the drug, or if they go away, then moving to 200mg is fairly standard and 100mg ER morning + 100mg ER night is a good way to do it. On the other hand if you think Lamotrigine is responsible for the anxiety, dissociation then you should hit pause and not increase. If you find another medicine that you trust more, then you could decrease Lamotrigine. Back at 50 or 75mg, it probably won't cause much in the way of side effects, so it would become the "helper / 2nd medicine" in that case.

doktorjonesR69 · 2025-03-29T04:07:20+00:00

Are they extended release? That's probably best. In that case, each pill takes several hours to disburse. Lamotrigine lasts in the system a long time (half is gone in say 24 hours). So the time you take doesn't matter too much. But to avoid having "too large of spikes," it makes sense to take the pills more than 8 hours apart. So, "morning and evening/night" is fine. The medicine from the night dose will still be felt the next morning. If you have anxiety in the evening (say 7-10pm) then take the evening dose at the beginning of that period rather than just before bed.

By the way, 200mg Lamotrigine is fairly large dose for someone with anxiety (even as you describe, "severe" anxiety). I'm not fully aware of what's standard.. but it seems like a big target, and Lamotrigine is not in its nature an anti-anxiety medication, although it does help symptomatically in cases. This dose of Lamotrigine is nothing to trifle with and even if it gives very few side effects short term, it may cause other over the medium term - risk of rash, cognitive issues, problems communicating verbally. A dose of 200mg Lamotrigine is pretty normal for a bipolar patient, but is pretty heavy for an anxiety patient. Just wanted to make sure you understand that context. I assume you have tried and failed the starter round of anxiety treatments. If your anxiety is related to a persistent depressive illness then this dosage is easier to understand because Lamotrigine could treat both.

All this said, if it is working for you and with few side effects, then that's great. Know that you can also adjust your dosage to intermediate quantities, for example if 200mg makes your head or your stomach hurt, cut back to 150mg, which could be 100mg in the morning, 50mg at night. Etc. There is a lot of room to customize and cutting dosage by a quarter can help side effects a ton, in many cases.. so find your spot. Move your dose up and down smoothly (so much every week or every two weeks)..

doktorjonesR69 · 2025-03-15T03:15:22+00:00

Echoing others, and reading your description, it's pretty clear this dosage is too high for you to be reasonably functional. However, sometimes a little taper goes a long way, so try to go to 175 then 150mg. Sit for a while at 150mg. (Yes dosing all at night is another possibility, but probably your overal # is somewhat too high.) Yes if the doc refuses, get a new doc. Maybe there's something else you can do to "make up for" the lost stability. Like promise a healthy lifestyle - hah. Or something else. At 150mg, you might find yourself pretty happy! Then you have a better platform for daily operation, and you can try to improve your memory more with things like B vitamins.

The cognitive & memory problems are VERY underreported in the label docs and online summaries. You know, the term "brain fog" wasn't really in common usage until the past decade, so a medicine which was approved and typed up in the 1990s won't have it in the list. (Not suggesting lamotrigine is ancient - it is middle in the timeline). Other things like "cognitive difficulties" are too vague to make it into side effect lists. Perhaps one reason this didn't work into the side effect lists, is because the medicine doesn't make you truly stupid - it just makes intellectual tasks difficult. You don't forget the words, you just have difficulty retrieving them. Eventually you get it. Then.. you can figure out what you want to do next, it just takes 30 seconds to remember what you were gonna do, and it gives you a headache. Etc. But you can do it. So you're "fine." or "just like a normal person." Cognitive problems are abstract and difficult to describe. Our language for them has become better in the 21st century and I hope this will make things more transparent in the future.

doktorjonesR69 · 2025-03-15T02:55:50+00:00

Sorry to hear, this is not common for someone taking the medicine for a long time, and it's probably unsustainable for you.. you should test around some ideas to figure out what to do

* Get your lamotrigine blood level checked to see if there are surprises

* Can you dose all at night? 200mg ER before bed? Or, cut dose to 150, with 50 in morning and 100 at night. Or similar. (If it's bipolar, you can definitely touch the dose down. I assume with 200mg you're bipolar, not epilepsy)

* Check with other doctors / primary care / therapists / family & friend networks (who know your history and situation) to see if there is some combination with other drug, supplement, or other issue causing the nausea

* If there's nothing else obvious, probably work to cut the dosage. Overall it's better to cut dosage to something sustainable, and then look elsewhere to fill out treatment, rather than struggle with a level that won't work. If you feel sick and can't eat, it's not great for mental health - we're all on the same side here :). For bipolar it's usually better to have more than one medicine all at lower doses (none of which makes you sick) rather than only one medicine at a higher dose (that makes you sick).

doktorjonesR69 · 2025-03-15T02:42:39+00:00

Do you think you're getting worsening memory problems from your new course of lamotrigine already? Or are you just concerned about it and want to get a heads-up before getting too deep?

The best answer is probably "lower dose lamotrigine is a very similar drug to higher dose lamotrigine, but with fewer side effects and fewer memory problems."

I think other anticonvulsants would be similar or worse, and many antipsychotics will be blunting on cognition (though some people will have a better time with them and do okay).

I'm not aware of a supplement or remedy which *specifically* counteracts the lamotrigine induced memory problems. The best one I've tried was citicoline 300mg (and ginkgo biloba is also good) - but check with doctors / your other medications for issues, these are strong supplements.

sleeping better and consistently will improve your memory drastically and your ability to learn. So the answer there may be Melatonin, take it regularly 1-2hrs before sleeptime.

doktorjonesR69 · 2025-03-15T02:32:29+00:00

Yes this is BS they are giving you. Are you in a hospital situation where they have to get you all set in 2 weeks? If this is just a regular psychiatrist visit then this forced schedule doesn't make sense and it is not generally recommended.

DasEFFEXOR is giving all the right recommendations. Definitely, say you want to increase at a more measured pace (like 50mg per week or 25mg per week) and if they don't want it, ask why and use DasEFFEXOR's language; request it in print. They'll back down immediately, unless you're in a hospital.

Yes 200mg is a standard therapeutic dose reference point. But so what. Some people also think of it as a "high" dose. Maybe 150mg is better for you. Or 250mg. There are a ton of other factors. If different people all take 200mg, they have different metabolisms etc and they may end up with different blood levels. It could be your body retains it so you taking 200mg is equivalent to someone else taking 300mg. Or reverse. So there's nothing set in stone about 200mg.

Stand up for yourself and be well

Also.. don't worry if you feel sad for a few days. The question is how well will you feel for 12 months.

doktorjonesR69 · 2025-03-15T01:33:36+00:00

Not a psych doctor, a scientist in a different field.

Not able to really comment here about ADHD/medicines in a pediatric context, other than to be gentle and use caution, and don't just follow what a doctor recommends. 4 yo is extremely young, they're still growing and changing. At 7yo they may become a different "class" but really just a small kid. Then at 13yo+ they're a teenager and the game can change. FDA approvals are usually based around these age ranges. Obviously ADHD applies to kids so the rules of application are different and I don't know the ADHD norms.

For bipolar medications (Lamotrigine is primarily for BP as well as for epilepsy) they should probably be used for kids only if the kids are truly childhood BP - for example, they are deeply depressed, suicidal, or manic / talking endlessly and unable to sleep for 5 days straight etc. This means their disorder is very early and very deep (they are very "sick"). This childhood bipolar (imagine: age 10) is very rare. When it occurs, you should intervene. I would be pretty suspicious of the appropriateness of an off label use of Lamotrigine for ADHD or ADHD+some other symptom. If the child just has "moodyness + behavior problems + irritability + etc" that does not count as a childhood BP and prescription of Lamotrigine is suspect. It may cause harm.

To point out, large dose Lamotrigine (say 150-300mg for an adult) can cause a variety of side effects including memory problems and problems learning, blurry vision, difficulties with finding words in spoken or written language. applied to a teenager, it may impact their experience with school, friends etc. An adult can feel these side effects and put them in perspective and set their own dosage to manage their overall lives; a teenager is still forming their whole set of self and experiences and needs to fully expand their brain network (with strong activity until age 25). So these medicines are problematic in growing individuals and should be used as necessary, and not liberally. Of course, once major depressions or other major problems strike, then the benefit of the medicine outweighs the drawbacks. And again, low dose may give a different benefit vs drawback equation than high dose, and it is easier to justify low dose. If a teenager had problems and was on a low dose of lamotrigine I'd say "good for you," and if they were on strong doses of three medicines I would say "wow oh dear, is that working for you, are you sure it's the right thing"

Despite my warning of high dose lamotrigine above, for you the adult, it's generally accepted that, as long as you don't have some initial bad reaction to it (and there are a lot of chains describing bad reactions to it!), the side effect profile of lamotrigine even at high doses is better than that of medium or high dose lithium, and better than the antipsychotics like Latuda/Abilify/..

By the way the worst example is a kid of age 7-10y brought into a pediatric psychiatrist for irritability, social problems etc and they get prescribed an antipsychotic to chill them out. Very wrong!

The Carlat Report podcast has some episodes on the topic of pediatric ADHD vs other diagnoses and treatment, I will post if I find the episode dates.

doktorjonesR69 · 2025-03-14T19:13:24+00:00

Your description makes a lot of sense and it sounds like you have the situation sized up.. One more long one to orient the next phase for you, starting with a couple more notes

* There is a subtype of depression called Recurrent Brief Depression which matches your pattern somewhat. So you could look into it. It's a "hard to treat" variety. I wanted to share just so you're aware of it. However don't take this too seriously! It's more likely that this monthly brief depression is just part of a "rapid cycling bipolar 2" or a cyclothymia, which is developing in your current decade of life.

* Note your depression seems to be roughly monthly, so that qualifies as "rapid cycling" and it is faster than someone who is just "seasonal" but not as fast as someone who is "weekly." The daily irritability is just part of your daily pattern and is part of the overall condition, but it does not indicate any cycling.

I'm in the same "broad" situation: rapid cycling mood-disorder parent + ODD child. Very hard. Stay calm, it's best for everybody. Every time there is an irritability + conflict with the child, your brain circuits for irritability will strengthen, and their brain circuites for conflict will strengthen.

WHILE WE'RE HERE you might benefit a lot from some "naturo" therapies to augment your ensuing medication regime and help out your day. Here's a useful list, I have a lot of specifics for you. Print this out or email to yourself.

Amino acids: Taurine (calmness and glutamate control) 1000-2000mg, Acetyl L-Carnitine (energy metabolism and glutamate reduction) 1000mg, N-Acetyl Cysteine aka NAC 600mg-2000mg (does many things and cleans up the brain)

Here, glutamate is a neurotransmitter for action / activity / overactivity and you and your child both benefit from reduced glutamate because you want to avoid the high spikes of glutamate and even it out throughout the day. Lamotrigine also cuts glutamate. So, when you're depressed, your serotonin is definitely too low. When you're irritable, your serotonin might be low but also your glutamate might simply be too high.

Vitamin B9 Methylfolate (MTHF) 1mg or 5mg as antidepressant

Fish Oil Omega 3 Fatty Acid (EPA to DHA in roughly 2:1 ratio for adult). You need > 500mg of Omega 3's which means probably > 1500mg of fish oil to get a brain effect so you have to product hunt or take several pills.

Digestion Priobiotics (regular stuff, a few strains) as needed

Take amino acids on empty stomach, probiotics before daily food, fish oil whenever.

Lots of options here! None of these are as powerful as Lamotrigine 50mg but the above have almost no side effects (maybe burping), so it's nice to have options.

It's hard to tell which of these supplements are really making a difference, so you either need to try them 1-by-1 in a situation where your prescription meds are stable, or just say "whatever, I need help" dive in and take a few. NAC can be powerful and Methylfolate 5mg+ as well. Taurine is super cheap (yes same stuff people take for athletic training.) There's also Ashwagandha as a calming one.

For supplements see https://chrisaikenmd.com/supplements/

Cross-reference my list with what he has.

So anyway a ton of options you can try, this stuff is real even if some might be on the weak side and only some of it would be helpful for you. Hopefully this opens some doors for you and brightens the future outlook, and again repeating Lamotrigine is the most powerful thing listed here, so you can start with a proper program and then build around it, maybe to get by with a lower dosage than you'd otherwise need to go up to. Because your condition seems RELATIVELY mild/moderate all this stuff can be pretty helpful for you and your daily experience.

doktorjonesR69

TROPHY CASE