Below you will find a number of topics for discussion and study, including uses for the drug, side effects, notes about withdrawals, and other frequently searched topics of information about Lamictal. There are some special safety notes and warnings that anyone considering starting or stopping Lamictal (lamotrigine) should be aware of.
Lamictal is used for epileptic seizure prevention and control, and to treat the manic and depressive episodes of adult bipolar disorder.
It is approved for use in children as young as 2 years old as an anticonvulsant medication to prevent epileptic seizures.
Lamictal is the brand or trade name for the generic drug lamotrigine. There is no known slang or street name for the drug, and there is no evidence that the drug has been associated with street or illicit use or sale. There are many alternate names for Lamictal, including domestically:
And just some of the international names include:
In April 2018 the FDA issued a new warning regarding anti-seizure medications including Lamictal precipitating a rare but life-threatening reaction. This reaction is described as a severe immune system inflammation, called HLH or hemophagocytic lymphohistiocytosis which can quickly escalate, especially if not treated quickly, and can lead to death.
Some signs of HLH include persistent fever and low or absent natural killer cells, and certain other characteristics in the blood that are markers for HLH. Mortality rates for HLH are 50%, and it occurs in children more often than in adults, which is a concern since Lamictal is approved for patients aged two years of age and older. (1)
Other severe though rare side effects that can present include:
There are also many more frequent side effects to be aware of in taking Lamictal, including:
It should be noted that since many very young children are placed on Lamictal for epilepsy disorders, that careful monitoring should be on-going for any signs of these or other unusual or adverse reactions to this drug.
Lamictal withdrawals can be mild, moderate or severe and medical oversight is recommended to anyone considering withdrawal from the medication. If the withdrawal is too sudden, some people have reported seizures. Gradual cessation is the recommended way to come off Lamictal. Some people will have little to no withdrawal symptomology, some may have much more severe discomfort.
Some of the other symptoms to watch for during withdrawal may include:
Lamictal should never be stopped abruptly, unless as in the case of HLH, or Stevens-Johnson syndrome, or other dire situations as noted above, where there is a medical emergency that requires such measures as a life-saving maneuver. These require immediate hospitalization.
In the vast majority of cases a gradual taper is the recommended procedure for coming off a mood stabilizer to avoid a sudden shock to the body that could leave the person in a worse off state than before the prescription was initiated.
Lamictal influences two amino acids, aspartate and glutamate. These are excitatory neurotransmitters, which Lamictal restricts the release of, thereby causing a calming effect. When gradual tapering is occurring, more of these excitatory agents may start to release into the system and this may cause rebound excitability.
Lamictal restricts presynaptic permeability of the excitatory amino acids aspartate and glutamate. When a person is withdrawing from the medication, it is generally accepted that more of these excitatory amino acids, with stimulatory neuromodulating capabilities, will begin to flood into the synapse, and there may be a rebound excitability. Aspartic acid and glutamic acid are the acidic versions of asparate and glutamate. This can be further compounded if foods containing versions of aspartate and glutamate are consumed during the withdrawal period. Therefore, foods such as diet sodas, processed foods, and artificial sweeteners (which break down into aspartate) should be restricted. One can do a search for foods that contain aspartate and glutamate to be sure these can be avoided. This modified diet may help significantly during Lamictal withdrawal.
Information has been collected here covering some often asked questions about the drug’s classification, its properties, how it is used in treatments and several other topics.
Lamictal dependence can occur over time, as with any medication. There is a lot yet to be learned about how Lamictal and similar drugs work, but it is known that the body can build up tolerance to a drug, and that side effects can become problematic.
The decision to come off Lamictal should be carefully assessed in the context of why it was prescribed, and whether the drug has or has not increased the health and quality of life of an individual.
Because of the inherent risks involved with Lamictal, withdrawal should only be done under medical supervision so that the process can be done in a safe and controlled way.
When choosing help, be sure to ask if the professionals who you will be working with have specific experience working with patients coming off Lamictal, and medication withdrawal in general.
In addition to the above discussions with your physician, don’t be afraid to ask about the complications that the doctor has personally seen, and how they might have been resolved. Certainly, if he or she has been doing medication withdrawal and has attained competence, there would have been some rough cases along the way. Sometimes, certain cases would like outside of outpatient capacity to treat. Knowing the difference is mastery and sometimes a second opinion is pragmatic.
The prescribing doctor may be reluctant to withdraw a medication that they have invested faith into. A doctor that specializes in medication withdrawal may have unique viewpoints worth considering.
These questions would probably be even more important to explore primarily if outpatient treatment is being considered. Antipsychotic medication withdrawal complications may sometimes fall outside the capacity of an outpatient treatment setting. Seek second opinions, and keep asking questions until all the information you need has been provided so a confident treatment decision can be made.
If mental health issues, for example, depression or the beginning signs of mania, were not met with holistic, medical or other drug-free exploratory methods and investigations before prescribing medication, then no real attempt to discover why these symptoms were present ever occurred. Holistic psychiatry would incline toward such investigative work well before prescribing medications. (5)
An inpatient program that does implement investigative testing might be a considered approach leading to bonafide solutions that do not have to include prescription drugs.
The Alternative to Meds Center does offer such investigatory work as part of the usual programs, as well as safe tapering methods administered by physicians with decades of experience in medication withdrawal. We encourage anyone in this difficult situation to become more acquainted with our resources and our program features. Please contact us for more information which is freely offered through our center.
Dr. Motl is currently certified by the American Board of Psychiatry and Neurology in Psychiatry, and Board eligible in Neurology and licensed in the state of Arizona. He holds a Bachelor of Science degree with a major in biology and minors in chemistry and philosophy. He graduated from Creighton University School of Medicine with a Doctor of Medicine. Dr. Motl has studied Medical Acupuncture at the Colorado School of Traditional Chinese Medicine and at U.C.L.A.