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Dr. Z
Dr. Z, Psychologist
Category: Mental Health
Satisfied Customers: 10564
Experience:  Psy.D. in Clinical Forensic Psychology with a background in treating severe mental illnesses.
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How do I wean off of lemictal.....I am on 450 mg as a mood

Customer Question

how do I wean off of lemictal.....I am on 450 mg as a mood stabilizer for my panic disorder and have been on it with 20 mg of lexapro. 2 mg klonipan 2 x per day. i do not feel any better except of the klonipan and I have been on it for a year. 2 years ago i ended up in the hospital do to panic disorder since that time everyone wants to change my meds including my MD and my psych. All different reasons but don't want to have long term treatment with any of these. Would just like to be on the klonipin as needed. my doctor said if I don't follow his prescriptions then he will not treat me and to find another doctor. how can I get off of these meds and if I do will I go back to the panic attacts. I have had panic disorder since I was on a plane that made a crash landing and have suffered with it on and off. I also have a sleeping disorder. This is longest it has lasted it has been 2 1/2 years total since I got out of the hospital and all of that time its been nothing but changing meds. What suggestions to you have
Submitted: 1 year ago.
Category: Mental Health
Customer: replied 1 year ago.
My doctors seem to thing that when I have a panic attack and dont want to leave that day I am depressed in fact on doctor dx me with MDD. my husband laughs as he thinks I am the last person the be depressed. And he is a Chiropractor and sees many depressed patients due to pain
Expert:  Dr. Z replied 1 year ago.
*This website DOES NOT constitute treatment and only provides information and advice. For treatment (therapy and/or medications) you must go to a licensed professional in your area. Please note that anything said here is not private or confidential, as this is a public forum.
Hello, I believe I may be able to help you with your concern. I am very sorry that you are having this issue with your medications and your doctor, I can understand how distressing this can be for you. If you are still suffering from panic attacks than if you taper off all the medications your panic attacks will most likely continue unfortunately and could worsen as well. I know you want to stop all the medications, but I would recommend finding another doctor to treat you as the trust in your current doctor is not there and also your current doctor has not been very helpful to lessen your symptoms. In addition, I would also recommend finding a new doctor because these medications are very strong and tapering off of them on your own is not advisable, especially the Lamictal and the Klonopin. Now with that being said the easiest and safest method to taper off the Lamictal would be to reduce the dose by 50mg every week. So it would like this:
-400mg/day for 1 week
-350mg/day for 1 week
-300mg/day for 1 week
-and so forth till you are at complete discontinuation
You can taper off all the medications at the same time as long as it is gradually, but again I would definitely not recommend that at all because your panic attacks would most likely worsen. Lamictal is a mood stabilizer that is primarily meant to treat depressive symptoms, there is only a minimal benefit for this medication to treat anxiety and panic, so I am surprised that your doctor prescribed Lamictal.
Since the Klonopin is working for you, it will probably be recommended that you stay on that medication. If the Lexapro (and in the past Zoloft) was not effective for you than your doctor may want to consider replacing the Lexapro with Remeron or Paxil. Remeron is not a SSRI antidepressant so you may respond better to that and also has a slight sedative effect which makes it a great medication for treating anxiety. The sedative factor can also help you fall asleep which is why it must be taken at night to begin with. In addition, you may be required to augment the Remeron with an atypical antipsychotic medication like Seroquel, Abilify, Zyprexa, or Geodon. The augments can help enhance the effectiveness of the antidepressant so that it is better at treating your Panic Disorder.
I would also recommend that you enter a form of therapy called Dialectical Behavioral Therapy (DBT) as this is a very intensive modality that can help you lessen the triggers of the panic disorder, build up your own coping mechanisms so that you mentally stronger to manage panic attacks, and can teach you different relaxation, distress tolerance, and mindfulness techniques so that you are not as overwhelmed by the panic attacks. DBT therapy also can provide you with a different avenue of treatment so that you do not rely soley on the medications and gives you more control in your treatment process.
I hope this answers your questions and provides you with some different avenues of treatment for your panic disorder. I am very sorry that you struggling with both the panic attacks and your own doctor, hopefully you will be able to find a new doctor and start a treatment regimen that will be successful for you.
My goal is to provide you with excellent service, so if you ever have any further questions or concerns please do not hesitate to contact me at anytime. If I answered your question satisfactorily I would very much appreciate if you could rate my performance in helping you so that I can get credit for this question. Thank you very much
Customer: replied 1 year ago.
Thanks for your help
Expert:  Dr. Z replied 1 year ago.
You are most welcome, I truly wish you all the best with your forthcoming treatment and I hope that these panic attacks and anxiety will lessen very soon for you.
*If you are satisfied with my answer, I would appreciate it if you can provide me with a positive rating so that I can receive credit for helping you today. Thank you

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