In the medical profession, Lamictal tapering proficiency is a special niche that not every prescriber is completely fluent in. It requires a specialist to guide the process strategically.
Lamictal side effects are not uncommon and it is reasonable to ask if a person who was once symptomatic should really be medicated for a lifetime knowing that there are other ways to approach mental health.
Does Your Diagnosis
Alternative to Meds has led the field in mood-stabilizer and antipsychotic tapering for over 15 years. We have published evidence demonstrating our success. Investigating medical and nutritional factors that may have been entirely missed, we often find that symptoms can be reduced by addressing these underlying factors directly, thereby reducing the need for psychiatric medications.
Watch this video of a young man who was Baker acted 13 times for psychosis and mania. Ryan recovered at ATMC and has been living medication-free for over 5 years now. He is now a mental health coach to others suffering from psychosis based upon his experiences.
A person may want to consider Lamictal tapering, for some very good reasons. At Alternative to Meds Center, Lamictal tapering protocols vary depending on whether a physician prescribed the drug to treat epilepsy or bipolar or other conditions.
15 Years Experience by Professionals Who Understand Your Journey.
FDA granted approval for prescribing Lamictal (lamotrigine) to prevent seizures in persons with epilepsy or other seizure-related conditions.1 The FDA also granted additional approval for use in delaying the onset of bipolar-related mania or depressive episodes. As time progressed, physicians began to prescribe Lamictal off-label, like so many other drugs, and as an add-on treatment for other conditions. The practice has become more common as time goes on.8
For example, Lamictal is prescribed off-label to treat PTSD, borderline personality disorder, anxiety, agitation after traumatic brain injury, and other conditions and types of mood disorders. Drug therapy has become nearly automatic for myriads of conditions and symptoms, but unfortunately, drug-based therapy can present consequences that are unsafe, and undesirable.2
Lamictal Tapering Guidelines and Schedule
IMPORTANT NOTE: The conversation about Lamictal tapering is from the perspective of it being a mood stabilizer, for instance for bipolar treatment. We are not suggesting that the same methods be administered to a person with a seizure disorder.
For persons with a seizure disorder, we cannot give viable guidance as your situation will need to be designed directly with your prescriber. And regardless of the reasons why Lamictal was prescribed, we recommend working with your prescriber or chosen health professional, not on your own.
Lamictal Tapering Guidelines Include:
Tapering Lamictal is best to begin when you are stable, with support from family or close friends and professional help in place before starting.26
A contract (meaning a written agreement) for safety should be drawn up with a trusted support person to prevent spiraling into re-hospitalization or other negative outcomes unnecessarily.25
Work with a qualified doctor who is familiar with tapering antipsychotic medications, who can prescribe, and who is willing to assist you in positive, helpful ways through the process.27
Steer clear of caffeine and other stimulants. Caffeine is found in coffee, chocolate, energy drinks, aspirin, and many other medications and should be avoided entirely where possible to do so.9
Eliminate recreational drug use, cut out recreational cannabis use.10,11
Eat a solid breakfast, protein-based, and maintain frequent feedings to balance blood sugar. 12,13
Cardio exercise is recommended for significant therapeutic value.14,15
For configuring taper amounts, your prescriber may use the lowest dose version possible (white 6-sided 25 mg).1
If tapering multiple medications work out a plan with your prescriber for the best sequence.
The time needed to taper will vary from person to person, but is recommended to be gradual in any case, for best success.16,27
Research possible withdrawal symptoms so they can be recognized and not misidentified as recurring or newly emerging mental illness, should these occur. These can signal that a further slowing of the taper may be in order.28
Inform your medical oversight of any red flag warning signs, i.e.not eating or sleeping.
Typically the end of the taper is the most difficult, sometimes requiring very small dose adjustments toward the end of the process.28
Discuss the possible use of bridge medication with your prescriber to overcome stuck points that are proving difficult to get past.34
Refrain from stimulating media such as repetitive music, tv, internet, over-involvement with social media, and overly stimulating religious or other highly emotive literature or media. Research has found that relaxing music or sounds such as rippling water have a profound effect on stress reduction.37
Help keep on an even keel with a calm environment and the use of relaxation strategies: yoga, Tai Chi, Qigong, massage therapy, light work, hobbies you enjoy, forest bathing, mindfulness training, outdoor walking, or other calming and engaging activities. 29-33,37
There are rare cases where ADRs (adverse drug reactions) require immediate cessation, such as Steven-Johnson Syndrome, which has been linked with Lamictal (lamotrigine).8
SJS is more prevalent in adults than children, and more often occurs in women than in men. Anticonvulsant-induced movement disorders are more prevalent with antipsychotics than with Lamictal but are known to occur.4 This level of medical intervention requires an ER or hospital setting. We are not in a position to give rapid Lamictal withdrawal guidance for these kinds of critical interventions involving rapid withdrawal.
Start Lamictal titration only when you are stable.
To prepare to start Lamictal tapering, some lifestyle changes are recommended. These include choosing a time when you have been on the medication for a while, and you have been reasonably tolerating it. You should be sleeping and eating well, practicing regular cardio exercise, having your support team including family, friends, and medical supervision in place. Your diet has been cleaned up if needed along the guidelines given above, and you are not relying on stimulants or involved with overly stimulating media. You are not drinking diet sodas loaded with Aspartame. You have eliminated recreational drug use, and you have a steady stable routine that includes exercise as well as relaxation, light work, or hobbies to keep engaged. If sleep becomes a chronic issue and has not been resolved with natural alternative treatments such as improving the sleep environment, melatonin, relaxation, or other therapies, consider asking your doctor for medication that can help with sleep.
Contracting for safety with a trusted person.
A person who is manic can have difficulty following directions. When a drug such as Lamictal is being tapered, it may feel so good that the person wants to speed up the process, or engage in activities that would put the person at risk. This can have drastic consequences and is why we recommend putting an agreement, sometimes called a “Ulysses contract”25 in place with one or more trusted persons that you agree that you will listen to before starting the taper. Then if that person says you have to go back on your medication at the direction of the doctor who is managing your taper, then you agree you will. And if you renege on your prior agreement, you acknowledge that the police or a hospital will most likely have to get involved. The best way to get a handle on this possible crisis is before it occurs. Abruptly stopping Lamictal for bipolar conditions is a recipe for disaster, and is something you and those around you will want to avoid. Contracting for safety is a tried and true method to safeguard against this problem happening to you.
Medical support for your Lamictal taper.
As difficult as it may be to find, we do not recommend tapering Lamictal without competent medical support. If possible, an inpatient setting would be most ideal. If your best resource is found in an outpatient setting, please do share the information on this site with your doctor to review and consider steps to utilize in the planning of your Lamictal taper.
Eliminate all forms of caffeine or other neurostimulators.
This point cannot be overemphasized. Caffeine is a neurostimulant. You may have relied on it without adverse effects while taking Lamictal. However, tapering Lamictal is a completely different circumstance. According to researchers such as Nehlig et al, 9 caffeine releases dopamine and activates noradrenaline neurons, which explains the stimulant effects on the CNS. The enhanced effects of caffeine stimulating the neurochemistry coupled with similar effects from reducing the dosage of Lamictal (that previously dampened these effects) has an exponential effect and can land a person in the hospital. This is why we recommend cutting out stimulants such as caffeine.
Stay away from Aspartame, as in “diet” sodas, etc.
Aspartame after ingestion breaks down into the amino acids aspartate and phenylalanine.5 Phenylalanine is a precursor to dopamine,6 and having more available dopamine is not advised during Lamictal tapering. Additionally, one of Lamictal’s believed mechanisms of action is to hold back the excitatory effects of aspartate (aspartic acid).7 So you do not want to flood the body with aspartate during a Lamictal tapering process.
Stop marijuana use.
There are strains of medical marijuana containing virtually no THC. Recreational marijuana, in comparison, does contain THC. Those who use marijuana containing THC are at greater risk for psychiatric symptoms and can sometimes end up in the hospital after suffering an episode of drug-induced psychosis or other manifestation. It could be that certain genetic profiles are at greater risk due to being unable to break down (metabolize) THC and it, therefore, can build up. More research is ongoing but the bottom line is that if you are coming off medication for bipolar conditions, you ought to stop recreational marijuana use. It is a wild card you do not want in your strategy for mental health.10,11
Diet strategies for maintaining level blood sugar.
It is well-known that spikes and dips of blood sugar put a person at risk of psychiatric and psychological adverse effects.12 While you are tapering Lamictal, you do not want to put yourself at risk by becoming hypoglycemic or hyperglycemic. Eat a good solid protein-based breakfast, smaller protein and vegetable-based meals, and healthy snacks over the day. This will help keep blood sugar levels even, provide adequate energy, avoid the spikes and crashes, and will support your taper very well.13
Exercise is well-established as a productive strategy for mental wellness. Another factor that is highly pertinent to tapering bipolar-related medication relates to mitigating (reducing the effects of) the flood of dopamine that can occur when decreasing the dosage of Lamictal or similar drugs. According to a study by Toone, oxygen is one of the cofactors in breaking down excess dopamine.14 Other co-factors in this process include NAD+, an enzymatic supplement therapy available at Alternative to Meds. Running, walking, cycling or other activities that get the heart rate up can be therapeutic in this way, as well as providing the many other benefits of increased energy, better mood, better sleep, and other positive effects.15 These strategies may be highly supportive during Lamictal tapering.
Use the smallest milligram dose of Lamictal available for the taper.
The smallest tablet dose of Lamictal 1 is the white six-sided 25 mg tablet (see image above). There are also dissolvable tablets. Asking your doctor to prescribe these smaller pills or those that can be dissolved in liquid for accurate measuring will make the math easier when it comes to cutting the dose accurately. This does not mean an immediate drop to the lowest dose. The following is an example of how using the smallest dose pills could help configure doses during the taper. For example, you are on 200 mg Lamictal. You can request to have the 25 mg version prescribed so that if you were to drop down to 175 mg, you could cut the 200 mg in half, giving 100 mg, and then add three of the 25 mg to equal a total of 175 mg. Your prescriber may consider the 100 mg and the 25 mg versions to make the math easier. Any of the Lamictal versions may be cut in half to configure the correct milligram dosing needed, however, if you are on Lamictal XR when cut will lose the extended-release attribute. They do make a 25 mg Lamictal XR version and also 50 mg and 100 mg Lamictal XR. So if you are on the XR version, many people can configure the tapering dosing amount in 25 mg increments. If smaller than 25 mg cuts are needed, your prescriber may decide a non-time-released version would be likely easier for that purpose. So let’s say a person is aiming to get to 87.5 mg. Three 25 mg Lamictal and 12.5 mg Lamictal (one-half non-time-release 25 mg tablet), would total 87.5 mg. Work with your prescriber to get the doses most easily configured to your needs.
Tapering multiple medications.
You may want to talk with your doctor about reducing/eliminating stimulant drugs first as these can be counter-productive during Lamictal tapering. These drugs would include things like Provigil, SNRIs, and others. These drugs stimulate the release of dopamine, which is the exact opposite of what you want to happen during Lamictal tapering.
On the other hand, if a person is also taking antidepressants, SSRIs, Gabapentin, etc., your prescriber may feel these could possibly assist Lamictal withdrawal. Talk to your assisting doctor about the option of staying on these until the Lamictal tapering is complete, or at least at a stable level. The strategy of carefully weaning off each one after that is another topic to discuss.
The choice between doing a benzodiazepine or the Lamictal first is a personal one, and at Alternative to Meds, each case is evaluated for the right strategy. If a person historically has a rough go at Lamictal withdrawal but does well with stopping benzodiazepines, we would likely do the Lamictal first using the benzo to soften the Lamictal taper. Conversely, the Lamictal might be helpful in softening the benzo withdrawal in the case where the benzodiazepine is the most problematic drug.
How long is my Lamictal taper going to last?
Our clinical experience at the center has demonstrated that generally, it takes up to one month, or longer, for each year you have been taking Lamictal. However, this can vary from one person to another. Some people can go faster coming off Lamictal than some other medications. The amount of support you can have in place can also make a difference. Not everyone may be a candidate for being completely medication-free. People who experience intermittent psychosis, or other symptoms such as mania, voices that come and go, tend to have a better outcome in tapering. People who experience constant symptoms even while on medications can tend to present more of a challenge in becoming 100% medication-free. These are discussions to have with your prescriber as your taper progresses.
Lamictal withdrawal symptoms.
If a person tries to reduce Lamictal too quickly, certain withdrawals can present, which can throw a wrench into the process.16 You can learn more about these on our Lamictal withdrawal page. Go slow enough that the changes can be tolerated without disturbing withdrawals. Tachycardia (racing heart rate), profuse sweating, mania, and other effects are signs that the withdrawal is going too fast and should be slowed down.
Red Flags of Lamictal Tapering.
There are signs you can watch for that indicate your taper may be going faster than your body can handle. Changes could be not eating or sleeping regularly. Also watch for obsessing over certain subjects or topics that could indicate slowing the taper down is the best course of action. Sometimes your prescriber may substantially raise the dose back up to a previous level until you are stable again, and then very gently work down again at a slower pace. Much like navigating a vehicle down an icy hill, you take it easy with the brakes for a gentle and safe descent.
Last Lamictal medication cuts likely the most difficult.
Generally, this is true for most medications and is particularly notable for tapering mood stabilizers and antipsychotic tapering. When you get close to the end of the taper, our clinical observations are that you would likely want to ask your prescriber to help you do the last cuts more slowly and increase the amount of time between each dose reduction. Research of Horowitz et al published in the 2021 Oxford Schizophrenia Bulletin advises extremely small reductions particularly at the end of the antipsychotic tapering process to ease withdrawal phenomena.28
Gabapentin as a bridge for Lamictal weaning.
It is not typical during Lamictal tapering at Alternative to Meds Center for us to use a bridge medication such as gabapentin. However, in some cases, it may be practical to use a bridge medication to ease over a particularly rough patch, for instance, during a stuck point in the taper. These matters can be discussed with your care provider, in case such an impasse occurs.
Limiting stimulating media during Lamictal tapering.
Repetitive music can be stimulating, but we suggest that it may not be advised for someone who is tapering Lamictal. This also includes spending too much time online or watching TV, phone texting, or being overly involved in social media. Perhaps focusing intently on religious ideation becomes or has been featured in your manic symptoms. In this case, we would recommend that you limit reading religious or similar material. Give that a rest. We support spiritual pursuits — however during Lamictal tapering, if it becomes problematic, one would be better off to extrovert the attention with outdoor walks or other light and enjoyable physical activity, listening to relaxing music or calming sounds such as rippling water, which can profoundly reduce human stress response.37
Lamictal Alternatives and Lamictal Withdrawal Links
However disconcerting it may be, consider that these mood disorders and seizure disorders are not completely understood. Also, neither do practitioners completely understand how mood stabilizers “work”.
At Alternative to Meds, we focus on exploring root causes and treating underlying factors and precursors rather than blindly or desperately masking symptoms. Our center offers much to benefit clients focused on similar goals. We provide much information on this site to explain how we take the time to test for and treat root causes for symptoms in very effective yet gentle ways, for instance, using a corrected diet as a strategy for mental wellness. That clearly differentiates our protocols from methods that can only mask symptoms. Most drugs cause some degree of anesthesia inherently. Because we seek to reduce symptomology using evidence-based treatments, the need to continue with drug-based therapy can often be reduced, or sometimes entirely eliminated.
How Long Should a Person Take Lamictal?
Before deciding how long a person should take Lamictal, one can observe there are many individual factors to consider. For example, tolerance, dependence, the intensity of Lamictal side effects, and other unique situations can vary from one person to another. If a physician prescribed Lamictal as a maintenance treatment for bipolar disorder, the length of time the FDA recommends taking Lamictal is limited to 16 weeks.1
The FDA clearly stipulates that the prescriber should re-evaluate the patient at that interval to find whether continuing the drug will be of any benefit to the person. If the physician decides to discontinue the drug, the FDA stipulates doing so gradually and not all at once. This would be a good time to consider possible benefits from a Lamictal tapering program. Careful monitoring and discussion with one’s caregiver can help to answer this question well for each unique person.
Lamictal Side Effects
If the prescriber gave lamotrigine to prevent seizures, the patient may express wanting to be freed of the unpleasant side effects that Lamictal causes. This may be especially vital where the drug did not control seizures as well as expected. Lamictal is also approved to be prescribed for bipolar disorder in adults, and has also been prescribed off-label, described more fully below in the “Off-label Uses” section of this article.
According to the black box warning on drug packaging, Lamictal is particularly known for causing rashes, some of which can be severe and life-threatening, requiring hospitalization to treat. 1,17,18,19
Tardive dyskinesia is a movement disorder caused by antipsychotic medications (and some other types of psychiatric medications) that is typically incurable once it presents. Although the FDA drug label (issued 1994, with revised text in 2015) does not stipulate tardive dyskinesia, it does include movement disorders, tics, spasms, extrapyramidal syndrome, and states that worsened Parkinsonism can occur. A later extensive review of the literature on drug-induced tardive dyskinesia authored by Cornett et al published in the 2017 Ochsner Journal36 does report on instances of lamotrigine-induced tardive dyskinesia, though states these are comparatively rare compared to other prescribed antipsychotics. The consensus on prevention of this type of drug reaction is to limit the length of time one is prescribed antipsychotic medications, and to keep the doses as low as possible. As there is no known cure for tardive dyskinesia, prevention is of prime importance.
Other risky Lamictal side effects include a condition known as hypersensitivity reaction. Hypersensitivity presents as an allergic-type reaction with fever, peeling skin, and other symptoms, and can be fatal. Other risks include suicidality and acute multi-organ failure.
Of special concern to parents, no safety testing has occurred on pregnancy outside of rabbits, rats, and other animal trials where birth defects, behavioral and skeletal abnormalities, infant mortality including stillborn births occurred in animals at all dose levels given, including less-than-recommended human dose levels. There is also a note that Lamictal enters human breastmilk at concentrations of 50% of the mother’s dose, and can produce adverse reactions in the nursing infant. These levels may further increase in the infant due to an incompletely developed clearance mechanism in the offspring.
Other warnings include aseptic meningitis (inflammation of the brain), liver failure, deafness, abscess of the breast, paralysis, and other fatal or life-threatening reactions that have occurred in persons taking Lamictal.
Commonly, less severe Lamictal side effects can reduce the quality of one’s life. This list includes symptoms such as slowness in thinking, memory problems, fatigue, dizziness, headache, insomnia, nausea, and so on. These symptoms can affect different people in different ways, and driving a vehicle or operating machinery is not recommended while experiencing these reactions. People differ in how well or poorly they can tolerate these common Lamictal side effects.1,35
Holistic Lamictal Tapering Support
We would love to share some exciting news!
Of great interest, studies3 have shown that strategically chosen foods in the daily diet can prevent or reduce the frequency and intensity of psychiatric symptoms and disorders, including seizures. In trials done on various types of epilepsy patients, regardless of age or gender, those following certain diet protocols experienced a drop in the frequency of seizures between 75% and 90% of participants compared to the control group, while the control group reported no similar reduction in the frequency of seizures. For a wide variety of epilepsy patients, other forms of nonpharmacological treatments such as Yoga, controlled breathing techniques, stress reduction skills, and meditation have also produced a statistically significant reduction in both frequency and duration of seizures compared to the control group of participants. The Epilepsy Foundation has published volumes of data concerning the positive results of utilizing diet in regards to seizure reduction.20
In the treatment of schizophrenia, depression, anxiety, insomnia, and other psychiatric symptoms, the diet has proven to be a powerful mediator according to studies published in the World Journal of Psychiatry and the Frontiers in Psychiatry Journal. 3,12,13,24
Cocaine and other addictions have been found prevalent in populations where bipolar conditions exist, particularly in those experiencing symptoms of deep depression. These patients sometimes are prescribed Lamictal as part of their therapy for resolving these addictions. Though these populations coincide, Lamictal addiction has not been commonly observed nor has Lamictal been found to have a street presence as a drug of abuse.23
Off-label Uses for Lamictal
Despite conflicting opinions seen in the medical literature on the subject, physicians often prescribe Lamictal for “off-label” uses.21,22 These could include depression, the treatment of borderline personality disorder, PTSD, or after a traumatic brain injury. However, it may be that Lamictal was not working as expected. So, one might consider safe Lamictal tapering in such cases, especially where a person is interested in pursuing some alternative non-drug-based treatments for their condition. A person may want to achieve a reduction or eventual elimination of medication in some cases. However, the person’s greatest hope remains — a reduction in symptoms as well. Alternative, holistic treatment options are sometimes overlooked in the rush for finding solutions, that could be significantly helpful in a wellness program.
Discovering Underlying Causes for Bipolar and Seizures
Many have found that alternative (nonpharmacological) treatments can be more effective and, fortunately, do not cause the unpleasant reactions found in the list of Lamictal side effects listed earlier in this article. The programs at Alternative to Meds seek to discover as much as is possible, the reasons why a person is burdened with unwanted symptoms. Testing can reveal whether toxic accumulations are a factor to address. We can address these underlying factors, and relieve the need for high dosages of neuroleptic drugs.
Adjunctive therapies such as counseling, equine therapy, correction of diet, relaxation therapies, and more, can be helpful during healing after drug use. Neuroleptics can become ineffective and even harmful if taken for an extended time frame. Lamictal tapering or reduction may help provide a better balance, reduce risks, and increase the overall benefits of treatment.
Contact Alternative to Meds Center
Alternative to Meds Center has helped many find alternative and supplemental treatments that can be just as or even more effective than only relying on medication. For those who have not found satisfactory outcomes with medication-based treatment, this may be of significant benefit to consider.
As always, please feel free to contact us at Alternative to Meds Center to find out more about treatment options that may interest you or a loved one. Certainly, we can help answer questions you may have about insurance coverage, length of programs, and other information that could help during your decision-making phase. The Lamictal tapering program at the center may provide you or a loved one an alternative path and workable options to realize better mental health and improved quality of life without a lifetime of unpleasant Lamictal side effects that can arise from drug-only treatment.
15. Sharma A, Madaan V, Petty FD. Exercise for mental health.Prim Care Companion J Clin Psychiatry. 2006;8(2):106. doi:10.4088/pcc.v08n0208a [cited 2021 April 14]
16. Gelisse P, Kissani N, Crespel A, Jafari H, Baldy-Moulinier M. Is there a lamotrigine withdrawal syndrome? Acta Neurol Scand. 2002 Mar;105(3):232-4. doi: 10.1034/j.1600-0404.2002.1c220.x. PMID: 11886370. [cited 2021 April 14]
34. Keks N, Schwartz D, Hope J. Stopping and switching antipsychotic drugs. Aust Prescr. 2019 Oct;42(5):152-157. doi: 10.18773/austprescr.2019.052. Epub 2019 Oct 1. PMID: 31631928; PMCID: PMC6787301. [cited 2022 Jan 13]
This content has been reviewed and approved by a licensed physician.
Dr. Samuel Lee
Dr. Samuel Lee is a board-certified psychiatrist, specializing in a spiritually-based mental health discipline and integrative approaches. He graduated with an MD at Loma Linda University School of Medicine and did a residency in psychiatry at Cedars-Sinai Medical Center and University of Washington School of Medicine in Seattle. He has also been an inpatient adult psychiatrist at Kaweah Delta Mental Health Hospital and the primary attending geriatric psychiatrist at the Auerbach Inpatient Psychiatric Jewish Home Hospital. In addition, he served as the general adult outpatient psychiatrist at Kaiser Permanente. He is board-certified in psychiatry and neurology and has a B.A. Magna Cum Laude in Religion from Pacific Union College. His specialty is in natural healing techniques that promote the body’s innate ability to heal itself.
Diane is an avid supporter and researcher of natural mental health strategies. Diane received her medical writing and science communication certification through Stanford University and has published over 3 million words on the topics of holistic health, addiction, recovery, and alternative medicine. She has proudly worked with the Alternative to Meds Center since its inception and is grateful for the opportunity to help the founding members develop this world-class center that has helped so many thousands regain natural mental health.
Medical Disclaimer: Nothing on this Website is intended to be taken as medical advice. The information provided on the website is intended to encourage, not replace, direct patient-health professional relationships. Always consult with your doctor before altering your medications. Adding nutritional supplements may alter the effect of medication. Any medication changes should be done only after proper evaluation and under medical supervision.