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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by fires on July 5, 2009, at 12:05:59
I've been on Lamictal in combination with Parnate for several years. I recently added Neurontin to the above. My response to Neurontin has been so good, that I want to try to discontinue Lamictal. (Bipolar, mild hypomania).
My pdoc stated that although increasing the dose has to be done slowly, decreasing the dose can be done quite rapidly.
Has anyone ever discontinued Lamictal rapidly? If so, just how rapidly? (I take 150 mg x 2/day)
If hypopmania returns, I can make a quick u turn.
Posted by SLS on July 5, 2009, at 13:02:07
In reply to Discontinuing Lamictal -- how fast?, posted by fires on July 5, 2009, at 12:05:59
> I've been on Lamictal in combination with Parnate for several years. I recently added Neurontin to the above. My response to Neurontin has been so good, that I want to try to discontinue Lamictal. (Bipolar, mild hypomania).
Lamictal is not a great anti-manic drug to begin with. However, let us say that it is helping to some degree. Have you been stable long enough on Neurontin to conclude that its beneficial effects will persist?
You can't taper too fast with Lamictal. There is the potential for rebound seizures. Still, you really don't have to baby the thing too much. Maybe you can cut 50mg at a time every three or four days. With Lamictal, I believe that it can produce a rebound depression when lowering the dosage too fast. It wouldn't be a true depressive episode, but why go through it? Actually, for you, I would worry about a rebound mania. It has happened with Lamictal before.
- Scott
>
> My pdoc stated that although increasing the dose has to be done slowly, decreasing the dose can be done quite rapidly.
>
> Has anyone ever discontinued Lamictal rapidly? If so, just how rapidly? (I take 150 mg x 2/day)
>
> If hypopmania returns, I can make a quick u turn.
Posted by bulldog2 on July 5, 2009, at 15:24:30
In reply to Discontinuing Lamictal -- how fast?, posted by fires on July 5, 2009, at 12:05:59
> I've been on Lamictal in combination with Parnate for several years. I recently added Neurontin to the above. My response to Neurontin has been so good, that I want to try to discontinue Lamictal. (Bipolar, mild hypomania).
>
> My pdoc stated that although increasing the dose has to be done slowly, decreasing the dose can be done quite rapidly.
>
> Has anyone ever discontinued Lamictal rapidly? If so, just how rapidly? (I take 150 mg x 2/day)
>
> If hypopmania returns, I can make a quick u turn.I have found neurontin to be very synergistic with other medications. I think it may very well work without the lamictal. If you can function on one mood stabilizer that is ideal. Of course the least amount of drugs is the best situation.
Posted by bulldog2 on July 5, 2009, at 15:24:40
In reply to Discontinuing Lamictal -- how fast?, posted by fires on July 5, 2009, at 12:05:59
> I've been on Lamictal in combination with Parnate for several years. I recently added Neurontin to the above. My response to Neurontin has been so good, that I want to try to discontinue Lamictal. (Bipolar, mild hypomania).
>
> My pdoc stated that although increasing the dose has to be done slowly, decreasing the dose can be done quite rapidly.
>
> Has anyone ever discontinued Lamictal rapidly? If so, just how rapidly? (I take 150 mg x 2/day)
>
> If hypopmania returns, I can make a quick u turn.I have found neurontin to be very synergistic with other medications. I think it may very well work without the lamictal. If you can function on one mood stabilizer that is ideal. Of course the least amount of drugs is the best situation.
Posted by Phillipa on July 5, 2009, at 16:27:50
In reply to Re: Discontinuing Lamictal -- how fast?, posted by bulldog2 on July 5, 2009, at 15:24:40
I"d guess 50mg at a time sounds reasonable. Although never got above 50mg stopped cold but only a few weeks and not manic. Phillipa
Posted by SLS on July 6, 2009, at 5:45:51
In reply to Discontinuing Lamictal -- how fast?, posted by fires on July 5, 2009, at 12:05:59
> If hypopmania returns, I can make a quick u turn.
I am pretty sure that the PDR says that you can discontinue Lamictal by tapering the dosage over the course of two weeks. You should check on that. I think the taper schedule I suggested is as fast as one would want to go. You might even decide to make adjustments at weekly intervals just to make sure.
- Scott
Posted by fires on July 6, 2009, at 13:58:21
In reply to Re: Discontinuing Lamictal -- how fast? » fires, posted by SLS on July 6, 2009, at 5:45:51
Thanks. I'll check PDR at local library.
Posted by bleauberry on July 6, 2009, at 16:08:08
In reply to Discontinuing Lamictal -- how fast?, posted by fires on July 5, 2009, at 12:05:59
I think any med, Lamictal included, should be tapered at whatever rate is comfortable and tolerable for the patient. We don't want to shock our already fragile systems. If there is time to do it right, I think it should always be slow and in tiny steps. For example, no dosage decrease larger than a 12.5mg step. Better still, 6.25mg steps.
A general guide of thumb is to decrease dose no faster than 10% per week. That usually pertains to antidepressants. But with mood stabilizers that do mysterious things we have no clue about, I think it becomes even more important.
Sometimes there isn't enough time to wean slowly. But if given a choice, it is in your benefit to avoid any potential trauma of withdrawal, worsened depression, or any other unpredictable thing that might happen. Some people can wean relatively quickly without much discomfort or complications. Others are very prone to complications. I think it is important to totally disregard what someone else did, disregard what any book or instructions might say, and instead listen to your own body's reactions to what you do. Your body will tell you if you are going to fast or too slow, or if the steps are too large or too small.
Posted by Ron Hill on July 9, 2009, at 14:20:38
In reply to Discontinuing Lamictal -- how fast?, posted by fires on July 5, 2009, at 12:05:59
> I've been on Lamictal in combination with Parnate for several years. I recently added Neurontin to the above. My response to Neurontin has been so good, that I want to try to discontinue Lamictal. (Bipolar, mild hypomania).
>
> My pdoc stated that although increasing the dose has to be done slowly, decreasing the dose can be done quite rapidly.
>
> Has anyone ever discontinued Lamictal rapidly? If so, just how rapidly? (I take 150 mg x 2/day)
>
> If hypopmania returns, I can make a quick u turn.
--------------------------Fires,
Everyone responds uniquely, so take my anecdotal Lamictal withdrawal symptoms with a grain of salt.
I am bipolar type II and I have been using Lamictal as a component of my med combo for about five years. In my case, Lamictal provides useful antidepressant benefits and mild moodstablizing action.
Roughly three years ago I attempted to reduce my Lamictal dosage from 200 mg/day to a target of 150 mg/day. My purpose for the attempted dosage reduction was a hope to lessen Lamictal-induced cognitive impairment side effects (e.g.; word finding problems, etc). I weaned my dosage downward at a cautious rate of 12.5 mg per week. However, at the end of the third week, corresponding to a dosage of 162.5 mg/day, I fell into a deep depression. I quickly ramped back up to 200 mg/day and the depression went away.
Why do you want to discontinue your Lamictal? Why not keep Lamictal on board with Neurontin?
Given that you only recently added Neurontin, do you think it might be best to keep everything else constant for a while? By doing so, you can delineate between any Lamictal withdrawal symptoms as opposed to any possible changes in your response to the recent addition of Neurontin. Just a thought.
-- Ron
dx: Bipolar II and mild OCPD
600 mg/day Trileptal
200 mg/day Lamictal
500 mg/day Keppra
60 mg/day Nardil
Posted by fires on July 9, 2009, at 15:23:50
In reply to Re: Discontinuing Lamictal -- how fast? » fires, posted by Ron Hill on July 9, 2009, at 14:20:38
> Fires,
>
> Everyone responds uniquely, so take my anecdotal Lamictal withdrawal symptoms with a grain of salt.
>
> I am bipolar type II and I have been using Lamictal as a component of my med combo for about five years. In my case, Lamictal provides useful antidepressant benefits and mild moodstablizing action.
>
> Roughly three years ago I attempted to reduce my Lamictal dosage from 200 mg/day to a target of 150 mg/day. My purpose for the attempted dosage reduction was a hope to lessen Lamictal-induced cognitive impairment side effects (e.g.; word finding problems, etc). I weaned my dosage downward at a cautious rate of 12.5 mg per week. However, at the end of the third week, corresponding to a dosage of 162.5 mg/day, I fell into a deep depression. I quickly ramped back up to 200 mg/day and the depression went away.
>
> Why do you want to discontinue your Lamictal? Why not keep Lamictal on board with Neurontin?
>
> Given that you only recently added Neurontin, do you think it might be best to keep everything else constant for a while? By doing so, you can delineate between any Lamictal withdrawal symptoms as opposed to any possible changes in your response to the recent addition of Neurontin. Just a thought.
>
> -- Ron
>
> dx: Bipolar II and mild OCPD
> 600 mg/day Trileptal
> 200 mg/day Lamictal
> 500 mg/day Keppra
> 60 mg/day Nardil
>Thanks for the info. I haven't had a bout of Major depression since 1988-- except when I stopped Parnate on the bad advice of a cardiologist. It wasn't until about a year after stopping Parnate that the Depression struck. I was given Effexor because my pdoc was concerned that Parnate had caused my previous tachycardia.
Effexor helped my depression, but for the first time in my life I experienced hypomania and mixed states. (At age 50!).I finally got off of Effexor and back on Parnate. The effects of Lamictal have been difficult to figure out.
I also take, in addition to Lamictal, for various disorders:
Parnate
Klonopin
Requip XL
Coreg CR
Florinef
Aciphex
Androgel
Neurontin (gabapentin)Now you can see why I want to try and stop Lamictal. :) (Klonopin, 1 mg at bedtime, is for sleep)
Posted by Tony P on July 10, 2009, at 21:10:37
In reply to Re: Discontinuing Lamictal -- how fast? » Ron Hill, posted by fires on July 9, 2009, at 15:23:50
The last time I did a complete withdrawal from Lamictal after long term use, it was fast: from 400 mg/day to 0 in 9 days. I don't recall having any problems, but everybody is so-o-o different!
I recently went back on it at 200 mg / day, along with Cymbalta & a couple of other things. I was experiencing severe tremor & anxiety so I quit cold turkey for a couple of days. I had no withdrawal symptoms as such, but I did have a hypomanic episode at about 48 hrs, so I went back on it. Since then I have taken 12 or 24-hour "holidays" when I needed to be free of the shakes, with no ill effects. I felt fairly safe going cold turkey having had previous experience with my personal reaction, but as usual YMMV.
I think the advice above is good -- start slowly and trust your body.
Tony P
Posted by fires on July 10, 2009, at 23:15:16
In reply to Re: Discontinuing Lamictal -- how fast?, posted by bleauberry on July 6, 2009, at 16:08:08
Sorry for the late response. I must have missed my email notification.
I agree with you in general, yet it seems to me that 50 mg/week is reasonable. I'm ready for any surprises. Fortunately, my hypomania (if in fact I even have/had it)is quite mild, so I can self monitor.
I see my pdoc in about 11 days, and I plan to remain mute on the subject until well into the appointment to see if she can detect any changes -- for better or worse.
> I think any med, Lamictal included, should be tapered at whatever rate is comfortable and tolerable for the patient. We don't want to shock our already fragile systems. If there is time to do it right, I think it should always be slow and in tiny steps. For example, no dosage decrease larger than a 12.5mg step. Better still, 6.25mg steps.
>
> A general guide of thumb is to decrease dose no faster than 10% per week. That usually pertains to antidepressants. But with mood stabilizers that do mysterious things we have no clue about, I think it becomes even more important.
>
> Sometimes there isn't enough time to wean slowly. But if given a choice, it is in your benefit to avoid any potential trauma of withdrawal, worsened depression, or any other unpredictable thing that might happen. Some people can wean relatively quickly without much discomfort or complications. Others are very prone to complications. I think it is important to totally disregard what someone else did, disregard what any book or instructions might say, and instead listen to your own body's reactions to what you do. Your body will tell you if you are going to fast or too slow, or if the steps are too large or too small.
This is the end of the thread.
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