Any woman taking Lamictal/Lamotrigine has seen the warnings about interactions with hormonal birth control (aka HBC). Taking The Pill reduces blood levels of lamotrigine by 40%-60%. Estrogen (specifically ethinyl estradiol) is the culprit, and it’s one of the body’s most powerful mood-altering substances. I jest not.
By the way, I wish women’s hormonal variability and resultant discomforts could be inflicted upon every single man on the planet – let’s say a year minimum, plus a month for every single ignorant “joke” or inappropriate comment about women’s reproductive systems. Would you like to be repeatedly publicly ridiculed about your normal bodily functions? No? Alrighty then, STFU or I’ll spike your beer with estrogen and then we’ll see who’s laughing.
Anyway. What you won’t find anywhere on the web (except in a short mention on CrazyMeds) is how lamotrigine interacts with natural hormonal cycles, which involve substantial variability. I dare you to find useful information on the topic of natural estrogen and Lamictal – and if you do, please post a link (and pat yourself on the back for outperforming a professional researcher with training in librarianship…)
Lamotrigine is intended to improve emotional stability for bipolar disorder. And it often does, but stability is fleeting when your body cancels out the drugs all on its own. Every damn month. More than once a month, because estrogen peaks twice in the normal menstrual cycle. See figure 1; I have studied this graphic about a zillion times in the last few months, desperately trying to understand WTF is going on with my body.
Low levels of estrogen cause depressive symptoms, among numerous other dysfunctions. High levels of estrogen will do the same. Estrogen also interacts with dopamine, which can mean serious bad juju. This is particularly notable for me with ADD symptoms (and I’d love to hear anything dis/confirmatory from others.) My memory and attention are so achingly lousy the week before my period that it’s like I’m unmedicated. The week after most women have PMS, when estrogen levels are lowest, is when I find myself in the throes of sudden, vicious, violent depression.
I also get a secondary dip at mid-cycle (ovulation) when estrogen levels plummet overnight. It doesn’t hit me as hard, perhaps because the hormone levels immediately increase instead of lingering in the week-long low that comes with menses. I’m usually at my best on the estrogen upswing, and it appears that my natural levels of estrogen are abnormally low (along with other really weird hormone levels), hence The Pill as a psych med.
When I was taking the super-low-estrogen pill awhile back, it slowly affected my mood, which dropped little by little for several months (Ruby noticed this much sooner than I did!) I attributed that to “seasonal effects” until I got labs showing that my lamotrigine levels were 1.8 ug/mL, while the normal therapeutic range is 2.5 – 15.0 (therapeutic dosage is much higher for epileptics, hence the wide range.) Increasing the dose beyond 200mg normally doesn’t improve mood stabilization – unless you’re taking HBC, when dosage usually goes up by 50%.
Now that I’m on a pill with average estrogen dosage, the overall mood drop-off has been much more noticeable, but at least I’m cognitively functional, so it’s a huge improvement. I’m skipping the placebos since cutting off the supplementation right when natural levels are lowest seems absurd, and my body clearly doesn’t compensate appropriately.
The estrogen is further suppressing my lamotrigine levels. Depression symptoms show up in the evenings and worsen until about an hour after taking my meds – at which point I feel OK – and that’s a good indicator that the drugs are wearing off too soon. Lamotrigine’s average half-life is about 25 hours, so the beneficial effects ought to last until the next dose, but no. It’s also completely fucking up my cycle – my body apparently does not care that it should not be menstruating or spotting continuously – something I just have to wait out for a few months, it seems.
I’m working on getting a new OB/GYN who doesn’t suck. The ovarian cysts are a nontrivial issue, since the little bastards are the size of a normal ovary all by themselves, and they hurt. The hormonal depression is not helped by more psych meds (tried that, even more misery ensued) and treating symptoms but not even bothering to look at causes is fucking stupid. What I need is a little respect and a referral to a reproductive endocrinologist.
So I’m off to make some phone calls to doctors. Again, some more, ad nauseum…
Rant: Pharmaceuticals and Gender Discrimination
Pharmaceutical companies need to trial drugs on men and women separately and equally, and analyze the results separately and equally. What works for a man may be ineffective or even dangerous for a woman. This is well established medically and scientifically. Neglecting to address this – given potential hazards – is clear gender discrimination. To earn consumer respect, drug companies needs to start delivering on ethical responsibility instead of wiggling their way around inadequate regulations. Big pharma makes a metric shit-ton of money off me, and I want appropriate treatment, dammit!
Oh, and HEY FDA – how about some regulations for gender parity? Equality does not mean identical treatment, and women aren’t even getting that much. Equality means correspondence in quantity, degree, value, rank, or ability. The FDA perpetuates Big Pharma’s discrimination against women by failing to require appropriate drug trials: correspondence in degree and value should dictate gender-specific drug trials, given physiological differences. It’s such an obvious issue that I consider it a form of civil rights discrimination – even if it’s not spelled out in the US legal code as such – and if I had the time and money, I’d sue for negligence and sex discrimination.