Tapering Lamictal

Patricia writes in the following question: 

I need advice on how to taper off of Lamictal. I am taking 100 mg a day. I would appreciate your thoughts on this.

Lamictal is an easy medication to get off of, as long as you don’t need it!  Any time you stop a medication, you must consider the possibility that you really need it to feel as good as you do . . . even if you feel pretty lousy.  It may be providing some measure of support that, once removed, will leave you feeling terrible.  Deciding to stop a medicine is a decision that should be discussed with the prescribing physician.  I also think it is a good idea to have a support person out in the real world that knows.  That way, if your insight goes before your mood does, someone can kick your butt back into treatment. That person can be a parent, an adult child, a spouse, a close friend.  It has to be someone you will listen to. 

Since Lamictal is a medicine that is used for depression (most commonly for Bipolar Depression) you must consider the possiblility that you might get depressed.  Non-phamacologic ways to avoid depression should be used to give you the best chance possible to stay reasonably happy.  By exercising, eating right, getting enough sleep, working with a therapist, reading good books, and practicing your spirituality (whatever that is for you), you increase the chances of doing well off medicine.

So, you have talked to your doctor, you have talked to a friend, you are doing all the ‘right’ things . . . how do you get off Lamictal.  I always like to go slow if I have the time.  I will assume that you have been on the medicine for about a year and are doing well and have no specific side effects of concern.  This is the best case scenerio, of course.  I would decrease you dose by 25 mg every two weeks or so.  That way you are off in about 6 weeks.  If you need to get off quicker, you can speed it up.  You can slow it down if you and your doctor want to play more conservative. 

One final note, I’m sure you are aware of the risk of rash with Lamictal.  This risk is NOT associated with a decrease in dose, it is only associated with an increase in dose.  While you must go slow in the titration up, you do not have to on the way down.  BUT, if you start having trouble, you cannot zzzzoooooommmm back to the high dose.  You must resume the titration schedule and go back up slowly.

I wish you well!

–Dan Hartman, MD

25 comments to Tapering Lamictal

  • Peter

    I have been on lamictal for a while and know it can cause skin rashes…..but can it make acne worse????

  • As a side effect to Lamictal, acne is listed as “infrequent”. That means somewhere between 1 in every 100 patients to 1 in every thousand patients. So, what does that mean. It means either that it has nothing to do with the lamictal and you have to figure out what that is, or, you are unlucky and you got the acne from the Lamictal. If it really works, it may be worth the pimples. If not, talk to your doctor. Actually, either way, talk to your doctor.
    –DH MD

  • J. Kircher

    I disagree that Lamictal is easy to get off of – at least for some. My husband was incorrectly prescribed it for depression that did not respond to SSRIs or Effexor. How do I know the Lamictal was wrong for him? It never helped and it made him feel worse. But now, trying to slowly get off is a living hell for him that far exceeds what he was experiencing before he was prescribed this drug.

  • I’m sorry your husband is having such a difficult time. As always, there are a select population that does poorly on any medicine. Your husband is, unfortunately, in that select group for lamictal. You didn’t give details of the medication trials or your husband’s symptoms, but just from what you wrote, there certainly seems to be options. Make sure that he had a good trial of at least two ssri’s (enough medicine for long enough–check other blarticles here about that). If Effexor is used in low doses, it is no different than an ssri–he must be on at least 150 and preferrably more in order for the medicine to be adequately effective at the norepinephrine receptor. Also, Cymbalta is an alternative that is well tolerated and hits both receptors from the git-go. You did not mention Wellbutrin–another option that works very differently from the ssri’s and can be key to people’s responce to medicine. As always, therapy/exercise/nutrition should be used no matter what medicine is being used. Now, the lamictal. Some docs are using Lamictal when people do not respond to antidepressants. Not completely unreasonable, but I prefer using the standard antidepressants unless there is evidence of a bipolar disorder. If he is really suffering, I would consider starting other antidepressant trials even as he comes off the lamictal. If the lamictal itself really made him feel lousy, it may be better to bite the bullet and just get off it quick. Sometimes this can be better done in an inpatient setting or in a partial hospital (day program). My best wishes to him and to you during this difficult time.
    –DH MD

  • Jeff

    Hey doctordan, I was in couns. For 11 months. blah, im 22. the same questions over and over. point being, I dont need to talk . Honestly. Im a smart cookie. Now, ONTO the LAMICTAL I have been Diagnosed with Bipolar II disorder with rapid cycling and panic disorder and anxiety. I am off in lala land now, What is that ? Is it the Citalopram, or lamictal . I have tried removing the others so far. I am unsure of playing with the others because I am unsure of the effects. I know that I am not going to go insane and cause my self harm. However, I have no energy and I just feel blah Its kind of like I went back in time. To a point before I was ever treated. The question is this, do you think decreasing the dosage will have any great impact or will cause it to be worse, the citalopram makes me sleepy but not enough to sleep. BTW 150 mg lamictal and 40 mg citalopram. This whole illness hit in nov 2005 and is realy consuming my life and its pissing me off. any help would be appreciated. This is affecting my ability to work, communicate with others. Its just crap. I need that special pill that grows a new brain… If you have any extra send them my way. PLEASE.

  • Jeff–Take a look at my entry from April 9th. I used your questions for a main article. Hope it was helpful. Let me know how things turn out for you.

    –DH MD

  • scarlet

    Hi. Im 29 y/o female. I started Lamictal July of 07 (150mgs) and since then I have developed horrible acne along my jawline that takes weeks to clear up and new pimples develop every other day. They are painful. I also have pimples on my chest. I’ve never had bad skin in my life. I also noticed that I have more peach fuzz on the sides of my face and the hair on my head seems to be thinning as well. This really sucks for me because the Lamictal is the first thing that has helped to get me out of depression. Im also taking Lexapro 10mgs. I want to get off the Lamictal to see if these nasty side effects subside, but Im also scared to be on an emotional roller coaster again. I stopped birth control (Yaz) about 7 months ago and thought that if I start back on it again, it may help with the acne? It is supposed to be FDA approved for bc, acne, and PMDD symptoms, so maybe my answer lies in that. Before making my decision to stop the lamictal, I’ll see my Pdoc and my dermatologist. Mental health issues are a big pain in the butt to deal with!!!!!!

    • Sara

      Hey, how is it going? I am in the same boat and would like to know how the yaz is helping with Lamictal acne. It can be hard to find people on the same meds as you when there are so many combinations. I’m not on lexapro though, but close enough.

  • Scarlet–take a look at the lead column for today. Your questions are good and, unfortunately, common.

    –DH MD

  • Jen

    Hi Doctordan, I hope you’re still out there. I’m Bipolar I, have been on lithium (1200 a day) since I was diagnosed in July, and recently decided to try something else due to 10-15 weight gain. I’ve been on Lamictal now for about a week (very low dose as I’m just building up–25 mg 2x a day), but I also have started to break out pretty badly. More than that, though, I feel as though I’ve been INCREDIBLY short-tempered and snappy in the last few days (I’m a teacher). Could that possibly be due to the Lamictal?

  • Jen–As noted in my blarticle for today, the issue of acne with Lamictal is a big problem for some people. The irritability that you describe can be from the Lamictal. It is unusual, but it happens. Make sure that you have a good ‘sounding board’ for your irritability (not the kids!) and that your doc is aware of the irritability. It could be that it is unrelated to the medicine. If it gets worse as you go up on the dose, you will need to try something else. While Lamictal is great, it does not provide the anti-manic effect that Lithium can provide, so I am not sure that it will really cover the scope of your symptoms. You might consider another mood stabilizer that is less likely to cause weight gain (such as Trileptal or Abilify).

    –DH MD

  • joelle

    I am on 600mg and was prescribed this medication a year ago. My doctor increased my dose from 50mg slowly taking me to 600mg over a period of 4 months. It took this much to feel less suicidal and even balanced in my mind. Recently I have felt concerned about this amount even though I feel completely normal and funtioning. How in the world do I begin to come down? I am not certain why I feel it necessary to begin taking significantly less, perhaps because there was a major power outage in the Seattle area and realized how the pharmacies were closed and I ran out. I hallucinated when trying to fall asleep and the paranoia I was suffering from frightened me. I know I should speak with my doctor and have him guide me. But he is of the strong impression I should remain on this dose. I am only trying to seek a second opinion. Thank you for your time.

  • I am on 150mg of lamictal for about 15 mos. now. My face has never looked worse, and I’ve noticed the peach fuzz too! I will not leave the house without make up…I wear it to the pool, even first thing out of bed. I never knew this was causing my terrible acne, but it is. I want to taper down quickly… so how fast is too fast? I have been cutting the tablets into quarters and taking 3/4, next week I will take 1/2, then the following 1/4. I don’t want to send myself into a frenzy. I am also on wellbutrin and 40mg of prozac. so i don’t feel like I need all this crap in my brain anymore! I have never been diagnosed Bipolar so I don’t understand why I was given this drug

  • Jennifer–

    Good question at the end there. Why were you put on that drug. As you know, it is typically used for bipolar depression but has been used with increasing frequency as a primary or adjunctive treatment for unipolar depression. Bottom line is . . . you’re taking it . . . you should have been told why. if you were not (or you forget) then you should ask. The answer to that question is really at the root of whether you should stop it or not. I am also big on having people talk to their docs about changes, too, so i hope they are in the loop. I usually go down a little slower than than (two weeks between changes of meds) but have been know to speed it up a bit when I need to. It sounds like you have really been suffering with side effects from the meds so i understand your haste. Please, tho’, talk to your doc!

    –DH MD

  • catherine

    Thanks for the tapering schedule. When I brought it up with my doctor she said to keep cutting by half but that wasn’t going so well. 25 mgs seems more reasonable.

  • Tony

    Hi, I myself am starting to taper off Lamictal and Im wondering what to expect from the side effects. I am taking 200mg a day and just recently started to taper off. Ive recently tapered of 25mg and Im noticing I am a little bit more irritable, more lethargic, a bit more emotional, is this normal withdrawal? And how long does it last? I’d like to understand what is going on in my mind.

  • Tony–As you can see with catherine above, it is often better to go slow. But slow is different for everyone. Whenever the time is available, i suggest that you allow for 2-4 weeks at a particular lowered dose to “re-equilibrate”. This allows for you to have good days and bad days (as we all do) without assuming that it is related to the change in medicine. BUT, you may need to go slower. If you really feel crappy for weeks on the lower dose and then feel better when you go back up, you can try going down slower . . . like by 12.5 mg every 2-8 weeks. You must also remember that you might need the medicine to feel OK at this time. You may need to reconcile to staying on the medicine for an extended period of time. Talk to your doc!!

    –DH MD

  • D

    Dear Dr. Dan,
    I’m a 45 y/o female properly diagnosed and treated as bipolar for 1 & 1/2 years. Prior to this diagnosis, I was treated soley for depression for 10 years (the last 5 as refractory.) I am presently doing GREAT on Lamictal 200mg daily and Effexor 300mg daily. The problem? I’ve had a rash on my leg for 2 weeks and only today made the connection to Lamictal’s potential for a life-threatening rash. I can rule out contact dermatitis. I’m not experiencing SJS symptomes. I will contact my ANP on Tuesday for evaluation and probably drug dicontinuation. My question? What titration schedule do you use to discontinue Lamictal? What titration schedule do you use to concurrently add another AED such as Topamax? I really appreciate your time and dedication to this topic! Have you had particular success with another AED? I can’t begin to tell you how well I have been doing since the addition of Lamictal. It changed my life. I hate to give it up.

  • D–

    See the article dated Sept 1, 2008.

    –DH MD

  • BikerMark

    Thanks for the tapering off information. I have been on a very low dose Lamictal (25mg a day) and I while it did help me with the manic episodes and depression(BP) I have had insomnia, blurred vision, and loss of balance (leading to a near death motorcycle accident 2 months ago). The side effects are no longer worth the benefits.

    Best wishes to all!
    M

  • souljah

    I have been on lamictal 100mg, Klonopin 4mg, and Lexapro 20mg for roughly 4 years now. As of the first of the month with a doctors help ive com off 3 mg. of Klonopin, stopped Lamictal after 1 week of just taking 10mg. and then am now starting on half of the lexapro. Sure my body is being pulled a bit in alot of directions bc of the change in brain chemistry. Anyone can do this, slow or fast, just remember to not push yourself too hard bc you only one brain, and time can heal. Truthfully, meditation has been a great contributer to the decreased anxiety during all of this. Also, of course talking yourself through the process, because from experience you can talk yourself into any side affect, anxiety, symptom, or depression and out of it as well. Its amazing how our thoughts can generate wild feelings, good or bad. Also, don’t read all these blogs about how horrible and painful and devastating this is because your prob. gonna freak and end up with a new diagnosis…sorry for those who are suffering im just tired of our instant gratification pill lifestyle… how did all those people years ago survive without em?

  • Crystal

    I was put on Lamictal temporarily for depression, and was slowly worked up to 400 mg. Now I am in the process of coming off of it. My doctor advised not decreasing more than 50 mg per week. I’ve been doing that, and now I am down to 200 mg, but I’ve noticed some difficulty breathing. I noticed it early on in the decrease schedule, but thought it was my asthma acting up. But I have noticed it again, after my latest decrease. Is this a normal side effect? I know it is one for being put on lamictal, but what about coming off of it? What would you advise? I may try decreasing slower, but I am not sure if I can cut the 200 mg pills more than in quarters without crushing it. What are your thoughts and recommendations? I haven’t had the chance to talk to my doctor yet, and am hoping I can get some advice asap.

  • Crystal–Breathing difficulties would not be a typical side effect of lowering the lamictal . . . at least not in my experience with patients. I would make sure your asthma regimen is maximized. If you want to go down slower, get a smaller pill. As a rule of thumb, the last bits of a medicine are the hardest to get off of. Typically, tho’, Lamictal is not that difficult to get off of.

    –DH MD

  • Margaret

    Interesting Crystal, I am having the same exact problem. Everytime I lower the dosage, (me going from 100mg just down to 50mg) I am having shortness of breath, heart palipatations and chest pain. I do believe its the lamictal! The only other time I had these same type of feelings was when I missed a dose. So I do think its the lamictal causing it. Is there any way to cure this shortness of breath while getting off the medication, its a nightmare!

  • kitty

    Crystal, I, too, am having breathing difficulties (I do not have asthma) and I am currently down to 200mg from 350mg. I am attributing this to Lamictal withdrawal. I believe that not enough is known about this drug.