Mari,
I hear how hard this is for you. Reading your post, I get the feeling of a large boulder sitting on you / me-reading, and another one hanging over my head waiting to fall down and smoosh me.
I think you have a good plan about waiting until January to figure out the pdoc thing.
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As for the Lamictal, here is what I would do:-
If after a week at 75mg you are ok with side-effects (you might be), go up to 100mg on a weekend as suggested. If not, stay at 75mg an extra week.
Tell him you didn't increase on schedule because you were still having so many side effects it interfered with work. You could even call and leave a message at his office to that effect.
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Lamictal is really the next thing in the pecking order, as mood stabilizers go:
Valproate, lithium, and the carbamazepine family of drugs are first-line mood stabilizers. The choice between them depends on the characteristics of mania (euphoric, mixed, presence of rapid cycling). You tolerate none of these.
It isn't your fault, but we do have to move down the list.
After that, the only "approved" options for mood stabilization are Lamictal and the AP's.
The latter are usually effective for activation, a couple are approved for depression. Most of them, however, have the potential for serious and permanent side effects, and
all of them cause heavy sedation.
Lamictal, with its murky indications, is mostly useful for its antidepressant qualities, which is a good thing for you. Its s/e's are generally less significant than with the AP's, also a good thing.
Next down the line, you have off-label drugs including verapamil, gabapentin, topiramate.
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So, really, Lamictal is a
very reasonable thing to try at this juncture. I understand you are feeling really bad and it is hard to be hopeful in these conditions. I'd like to encourage you, though, if you can manage it, to keep an open mind about the medication.
When we keep our mind open to something, we increase the chances of a positive outcome. I want a positive outcome for you.
(((
HUGS
)))
waves