Can Lamotrigine dose be reduced to 25 mg for depression?

Question

Hello doctor,

I am diagnosed with OCD and possibly depression. I have taken several different medications over the years and was most recently taking Lexapro 20 mg, Lamotrigine 50 mg, and Vyvanse 70 mg. Lamotrigine is the newest medication I was prescribed. I had gotten the dose to 150 mg, but then I started having panic attacks, so we lowered the dose to 100 mg. That was fine for about a week, and then I started having panic attacks at that dose. We lowered the dose to 50 mg, and in two weeks, I also started having panic attacks at that dose. It was helping with my depressed mood, but I have not taken it in the last three days. I am starting to feel more depressed, and I am not sure if it would be fine to take it at 25 mg or stop taking it all together. I was previously prescribed Abilify 2 to 5 mg, but I was concerned that it made me gain weight.

Answer 1

Hi,

Welcome to icliniq.com.

I have read your query and understand your concerns. First of all, I would like to inform you that possibility of panic attacks is dose-independent. I mean to say for panic attack-prone individuals, the panic attack can occur at a wide range (starting dose of 12.5 mg to 200 mg). However, it is observed that at a higher level, the chances remain much lower in some individuals. In other words, it can be stated that most individuals are prone to panic attacks at a certain range. For example, one of my patients had panic attacks in the dose range of 50 to 100 mg per day, but panic attacks ceased to exist once we crossed 100 mg per day. Secondly, I would like to state that it is most likely fear of panic attacks that are bringing panic attacks to you even at the lower dose on the current day (presuming slow titration, I feel it was not there when up-titration of Lamotrigine was done while building the dose of Lamotrigine). In other words, even our fear of panic attacks can bring more panic attacks, and controlling our nerves may help you. Thirdly, I feel that Lamotrigine should be tried again under cover of benzodiazepines (Diazepam or Lorazepam or Clonazepam or Alprazolam). My recommendation is based on the fact that benzodiazepines can take care of panic attacks while Lamotrigine can take care of depression. Over a period of time, the propensity to cause panic attacks will decrease, and benzodiazepines can be stopped slowly. Thank you.