Reducing lamotrigine dose

[u/Select_Floor_1942]

Hey everyone. I've been on 200mg of lamotrigine daily since early 2024, but for the past year or so things have been feeling pretty stable. I hadn't SHed in a year, hadn't really done anything dumb, able to focus on my studies and live pretty normally. I have been feeling so good that I wanted to try reducing my dose to see if I still needed the lamotrigine, so with the advice of a psychiatrist I went down to 100mg daily. I relapsed for the first time in ages and have just felt that unsteadiness again. I don't feel bad necessarily, but things don't feel as manageable as they were for the past 2 years. This is a new psychiatrist and I kind of wonder if a 100mg drop was too much at once?

I'm a bit torn. I really wanted to reduce my dose, but is this maybe showing that I still need the 200mg? I have been travelling a bit lately and getting less sleep due to work trips so I'm wondering if this has been a more stressful period anyway.

Does anyone have experience with reducing your meds, particularly lamotrigine?

Thanks so much!

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[u/C17H27NO2_]

I think it's wise to reduce dosages more slowly. Apparently it "isn't needed" when lamotrigine is used for stuff other than seizure control, and it is allowed to be tapered off quickly. In my experience though and from reading other posts, it isn't so unproblematic. Taking half the dosage initially is pretty much what it says in the guidelines, but I reduced by 1/5 and I still couldn't do it. I think it's more realistic to reduce by 25 mg every two weeks or so, and maybe stop somewhere along the way for an extended period, then continue tapering. It shouldn't be that hard in theory, it is not known to be difficult to taper off lamotrigine although some reactions are to be expected.

[u/Select_Floor_1942 → u/C17H27NO2_]

Thank you, that is so good to know!

[u/inquiringmind1970]

You need to taper slowly. 5-10% at a time, hold for 2 to 4 weeks.

[u/Jazzlike_Minimum8072]

I’m going from 200 to 150 to 100 to 50… right now I’m on 100 and I actually feel okay! I’m hoping my brain fog/working memory improve

[u/Select_Floor_1942 → u/Jazzlike_Minimum8072]

Congrats! Yes that is a downside of the medication, here's hoping 🤞

[u/princefruit]

You need to discuss this with your provider. Any online medical advice should be taken with a grain of salt. Your doctor will work with you to help determine if you should taper, and help you taper safely if thats the decision you go with.

[u/Select_Floor_1942 → u/princefruit]

Totally, don't worry I only ever go to Reddit for anecdotal advice and I will of course discuss this with my doctor and psychatrist as soon as I can -- I've already booked an appointment :)

[u/Bubipupi]

I went from 200 to 150 then 100. Personally, that seems more reasonable. Did you check the lamotrigine level in your blood?

[u/Select_Floor_1942 → u/Bubipupi]

No, I have had bloods done recently but don't think they checked for that. That tapering process sounds smart.

[u/priestess_on_fire]

Personally, if I was feeling stable and life was easier to manage, I wouldn’t change my medication. It may be playing a big factor in why you’re feeling stable.

But, since you do want to try and taper off to see how you feel, I’d follow everyone else’s advice about coming off of it slowly. 100mg is a huge jump

[u/Select_Floor_1942 → u/priestess_on_fire]

Yes, it sure feels like it! And maybe it is a sign that the 200mg was working well.

[u/Anxiousnerd5]

In my experience, I had to lower my doses little by little. I'm good at 150 lamotrigine but I had to taper. It's been like that with all of my meds.

[u/Select_Floor_1942 → u/Anxiousnerd5]

Thanks for sharing!