Hypomania with lamictal/lamotrigine withdrawal?

Post date: 2022-11-28 13:20:38

Some questions about hypomanic symptoms during a lamotrigine taper, inside.

My SO is now tapering off lamotrigine. He was on 200 mg for a few years. He cut to 175 mg and it's been just over two weeks. He is bouncing off the walls. Dancing, then irritable, then talking loudly, then getting upset... also sleeping less (currently at 6-8 hours a night, until recently was sleeping 10-16 hours a night, which of course wasn't good either, anyway).

A read of social media suggests this is common, including in people who have never experienced hypomania before (eg people who were on it for epilepsy!). My question is, how long might this last? Would he normalize without further pharmacological assistance or reinstatement of his original dose with some time? Does he need a temporary medication to help him through this period? Currently he's relying on indica and gabapentin which aren't doing much. And occasionally loxapine at night.

Worth mentioning that he recently tried and stopped two SSRIs (see my recent question). He's been on a medical magical mystery tour since the summer, it's just been awful.

The psychiatrist he's seeing originally had him set on a taper of -50 mg every two weeks, which evidently became impossible after two days (holy shit is all I have to say about those two days). So he's reducing by 25 mg. The follow up is booked for early Jan at which time she expects him to be off it. I mean this is just not going to happen, or if he tries he'll be hospitalized before then.

Online people recommend either a micro taper (tiny increments reduced daily), or only reducing by 5-10% a few weeks after withdrawal effects from the previous taper stabilize.

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