Lamictal (Lamotrigine) is a drug that is approved for the treatment of epilepsy and bipolar disorder. It works as a sodium channel blocker by inhibiting voltage-sensitive sodium channels. It is also thought to inhibit the release of glutamate at various areas throughout the limbic system. The drug has been found to be neuroprotective and is clinically effective at preventing the drastic changes in mood associated with bipolar disorder. In addition to acting as an antiepileptic drug and mood stabilizer, it is also used off-label as an antidepressant augmentation strategy.
Specifically, this drug is used to treat partial seizures, focal seizures, tonic-clonic seizures, and seizures resulting from Lennox-Gastaut syndrome (severe epilepsy). It was the first drug since Lithium to be approved for usage as a mood stabilizer and is commonly used as a maintenance medication for individuals with Type-1 Bipolar disorder. It has been found effective at preventing depressive episodes in bipolar patients, but isn’t as effective at treating manic symptoms.
Although this medication can work very well at managing epileptic and bipolar symptoms, some people don’t respond well to it. Others take this drug for an extended period of time and develop debilitating side effects. There is a black box warning associated with this medication in regards to developing Steven-Johnson syndrome and other life threatening skin reactions.
It is estimated that between 5% and 10% of people who take this medication will develop skin rashes and/or have unbearable side effects (i.e. aseptic meningitis, fever, fatigue, etc.). In many cases, the side effects associated with this medication outweigh the benefits of taking it. Most people will eventually want to withdraw from this drug.
Factors that influence Lamictal withdrawal include…
When it comes to withdrawing from any drug, there are going to likely be discontinuation symptoms. There are various factors that will play a role in determining the severity and duration of these symptoms. Factors such as: how long you took the drug, your dosage, whether you quit cold turkey, and personal withdrawal sensitivity can influence your discontinuation experience.
1. Time Span
How long have you been taking Lamictal? In general, people that have taken the time to titrate up to a therapeutic dose and have been on it for an extended period of time are going to become dependent on this drug for everyday functioning. When you consistently deliver a drug to your body and brain over an extended period of time, it will get used to having the drug influence its functioning.
Some would argue that using any drug for a long period of time creates dependency. The longer you have been on the drug, the more difficulty you are going to have adjusting to functioning (both physical and psychological) without it.
2. Dosage (200 mg to 400 mg)
Most people that are on Lamictal are on a dose between 200 mg and 400 mg. There are obviously individuals that are taking over 400 mg. People tend to titrate up to a dose that provides the most therapeutic effects. In general, the higher the dose that you are taking of this drug, the more intense the withdrawal symptoms. Additionally, withdrawal from a higher dose is thought to take longer in regards to tapering than withdrawal from a lower dose.
3. Cold Turkey vs. Tapering
In order to reduce severe withdrawal symptoms, it is important to titrate down from your current dose (i.e. conduct a taper). Tapering will give your body some time to gradually adjust to less of the drug. If you quit cold turkey, it can send both your body and brain into a chaotic state because they will be expecting to receive the drug.
People that have been taking Lamictal for an extended period of time have had to titrate up to their current dose. Therefore quitting cold turkey gives your body no time to readjust itself and is likely going to yield the most extreme withdrawal symptoms. Work with your doctor to come up with some sort of tapering protocol based on your current dosage so that you minimize your withdrawal.
For example, if you are at 400 mg, you may want to gradually reduce your dosage over the course of a 2 month period. It is also important to make adjustments in withdrawal based on how well you are coping. If you reduce your dosage by 50 mg and it feels like too much, you may want to go down by only 25 mg. During withdrawal, the name of the game is doing what works best for you.
4. Individual Factors
It is important to note that there are individual factors that play a role in withdrawal from every drug – Lamictal is no different. Some people may experience very minimal symptoms when they quit taking this drug, while others may experience severe symptoms. Withdrawal sensitivity is different depending on the person and that individual’s circumstances.
One person may have more social support, better habits, and a better tapering plan than another. Someone else may have a great tapering protocol, but that individual may be hypersensitive to withdrawal symptoms. It is important to recognize that how quickly you recover from withdrawal will largely depend on you as an individual – therefore it’s important not to compare how quickly you recover with others; you know your body and experience better than anyone.
Lamictal Withdrawal Symptoms: List of Possibilities
Below are some common withdrawal symptoms that you may experience upon discontinuation of Lamictal. Keep in mind that everyone has a unique withdrawal experience and that your symptoms may not be the same severity as someone else going through the same withdrawal. Although it is important to know what symptoms are caused by withdrawal, it is also important not to psyche yourself out.
- Anger: Certain individuals report having strong feelings of anger that emerge during withdrawal. If you are feeling excessive anger, realize that this can be a very tricky symptom to manage. When you get really angry, try to take a look at your situation from a third person perspective – the anger is a result of withdrawal. This anger should subside after a few weeks and/or improve with time.
- Anxiety: A very common symptom associated with discontinuation of this drug is that of anxiety. You may feel more nervous than you normally do during withdrawal. This anxiety may become excessive and/or lead to panic attacks. The best way to combat anxiety is to engage in relaxation exercises and focus on healthy activities to lower your arousal. Recognize that until your neurotransmitters correct the imbalance that is inevitable when coming off of a medication, the anxiety will persist.
- Balance problems: Some individuals have reported that they have trouble with balance when coming off of Lamictal. In some cases this could be due to too rapid of withdrawal, but in most cases it is just another discontinuation symptom. Your physiology will need some time to return to functioning without the drug. Just know that your balance should eventually recover.
- Bipolar symptoms: Individuals that are on this drug to help manage mood cycling associated with bioplar disorder may experience a re-emergence of symptoms. If you notice that you are entering into bipolar depression and/or a manic (or hypomanic) phase, it could be triggered by withdrawal. It is important to work with your psychiatrist so that you don’t have to deal with a re-emergence of bipolar cycling.
- Concentration problems: Many individuals experience impaired cognition and focus when they quit taking this drug. Not only are you going to be dealing with an array of physical symptoms, you may also have to cope with poor concentration for awhile. Your cognition and ability to concentrate should recover.
- Depression: Some people report that when they withdraw from this medication, they spiral down into a very deep depression. Just know that this is very common and withdrawal from most psychiatric drugs leads to feelings of depression that can sometimes seem insurmountable. The deep depression that is caused by withdrawal will not last forever.
- Dizziness: Do you feel dizzy after quitting this drug? It could be due to the fact that you tapered too quickly and/or quit cold turkey. With that said, general dizziness is an extremely common symptom. It is difficult to deal with and frustrating because your doctor will likely not be able to relate to this feeling when you describe it.
- Fatigue: A lot of people report feeling excessive lethargy and overall fatigue when they stop taking Lamictal. If the drug was giving them some energy prior to taking it, this could be a counter-effect. In most cases, the fatigue is simply due to the brain and body trying to readjust and function without the drug that it had been receiving for a period of time.
- Headaches: Many people have reported experiencing intense headaches (i.e. migraines) when they come off of Lamictal. Just know that this is a very common symptom to experience when you stop taking this drug. If they become bad, do your best to relax, drink plenty of water, and consider headache relief (over the counter).
- Irritability: If you feel excessively irritable and every little thing is making you mad, aggressive, and frustrated, it is likely due to the fact that you are coming off of a medication. Unless you were highly irritable prior to taking the drug as well, the experience of irritability can be chalked up to withdrawal.
- Mood swings: If you are bipolar and quit taking this drug that was used to stabilize your mood, it is obvious that you could experience mood swings immediately upon discontinuation. If you experience more severe mood swings than prior to taking the medication, it is likely due to the fact that some sort of imbalance was created by the drug. If you don’t have bipolar disorder and are having mood swings, just know that it’s a very common experience during withdrawal.
- Nausea: Some individuals report feeling nauseated when they stop taking this drug. There is not really much that can be done to ease this particular symptom other than conducting a slow, tapered withdrawal.
- Tingling: Many people report tingling sensations throughout their body when they initially stop taking Lamictal or miss a dose. This tingling may continue for a week or two, but eventually should get better as your body adjusts to functioning without the drug.
- Vomiting: Yes there are cases of people exhibiting flu-like symptoms when they stop taking this drug. The combination of nausea and dizziness can pack a mean punch that leads some individuals to actually vomit. Keep in mind that this is a less common symptom, but it shouldn’t last more than a week after you withdraw.
Lamictal Withdrawal Duration: How long does it last?
Withdrawal from Lamictal will vary depending on the person. There is no specific withdrawal duration that universally applies to everyone. As I already mentioned, there are a variety of important factors that will play a role in determining how long you experience withdrawal symptoms as well as how severe they are. Someone who has taken this drug for many years at a substantial dose may have a very difficult time coming off of it compared to someone who has been on it at a lower dose for a short period of time.
Most people report feeling back to normal after 4 to 6 weeks of the drug being out of their system. As a general rule of thumb for more extreme withdrawal, I recommend judging symptoms after 90 days (3 months) of withdrawal. If you are transitioning to a different medication, the new medication that you are on may ease and/or mask the symptoms of Lamictal withdrawal. Many doctors may discount your reports of experiencing symptoms when you stop taking this drug.
I always recommend trusting your own experience in regards to symptoms. If you know that you are experiencing withdrawal or some sort of discontinuation syndrome, you probably are. Additionally don’t compare your withdrawal with that of others on forums – everyone is likely to have a different experience. Your best bet for ensuring quick recovery from withdrawal symptoms is to recognize them and do your best to cope with them knowing that you will eventually experience a full recovery.