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
