Stopping Lamotrigine 25mg for Bipolar Disorder
Do not stop lamotrigine abruptly—consult your prescribing physician before making any changes, as premature discontinuation of maintenance therapy is associated with relapse rates exceeding 90% in noncompliant patients. 1
Critical Considerations Before Discontinuation
Maintenance therapy for bipolar disorder should continue for at least 2 years after the last mood episode, and some individuals may require lifelong treatment when benefits outweigh risks. 2, 3 The decision to discontinue after 2 years should be made in consultation with a mental health specialist. 2
Risk of Relapse
- Withdrawal of maintenance therapy dramatically increases relapse risk, especially within 6 months following discontinuation. 1
- More than 90% of adolescents who were noncompliant with mood stabilizer treatment relapsed, compared to only 37.5% of those who remained compliant. 1
- Lamotrigine is particularly effective for preventing depressive episodes in bipolar disorder, so discontinuation may lead to recurrence of depression. 1, 3, 4, 5
Safe Discontinuation Protocol (If Medically Appropriate)
Tapering Schedule
If discontinuation is deemed appropriate by your physician, lamotrigine should be tapered gradually rather than stopped abruptly. 1 While specific tapering schedules are not universally standardized, a conservative approach involves:
- Decrease the dose by 25mg every 1-2 weeks to minimize withdrawal effects and allow monitoring for early signs of mood destabilization. 1
- At your current dose of 25mg daily, this would involve reducing to 12.5mg daily for 1-2 weeks before complete discontinuation.
Important Caveat About Restarting
If lamotrigine is discontinued for more than 5 days and you need to restart it, you must begin with the full titration schedule (starting at low doses and slowly increasing over 6 weeks) rather than resuming your previous dose. 1 This is critical to minimize the risk of serious rash, including Stevens-Johnson syndrome. 1, 4, 5
Monitoring During and After Discontinuation
What to Watch For
- Early warning signs of mood episode recurrence: changes in sleep patterns, energy levels, mood shifts, racing thoughts, or depressive symptoms. 1
- Increased risk is highest in the first 6 months after stopping medication. 1
- Regular follow-up with your mental health provider is essential during this period. 1
Alternative Treatment Considerations
If discontinuing lamotrigine due to side effects or other concerns, discuss alternative mood stabilizers with your physician rather than stopping treatment entirely. 2 First-line alternatives for bipolar disorder maintenance include:
- Lithium or valproate, which are recommended for maintenance treatment of bipolar disorder. 2
- These should be considered before complete cessation of mood stabilization therapy. 2
Common Pitfalls to Avoid
- Never discontinue lamotrigine without medical supervision, as inadequate duration of maintenance therapy leads to high relapse rates. 1
- Do not attempt to restart lamotrigine at your previous dose if you've been off it for more than 5 days—this significantly increases the risk of serious rash. 1
- Avoid stopping all mood stabilization therapy simultaneously, as bipolar disorder typically requires ongoing pharmacological management to prevent recurrence. 2, 1