How do I talk to my boyfriend about his Lamictal dose?

I often get questions on how to talk a person with bipolar disorder about their medications.   Here is a question from Cheryl.  I use a tecnhnique called ‘scripts’ with all of my coaching clients. I explain a bit about scripts in my answer.

Hi Julie,

My boyfriend just started taking Lamcital about a year ago and his doctor only has him on 40 mg and it’s just not enough. After almost 20 years of refusing to take meds this is progress for sure, but both he and his doctor are being so very conservative I’m still waiting for the miracle to kick in. Don’t get me wrong, even at 40 mg it’s helped, but there is still irritably, cycling, sleeplessness, etc. His mom is at 400 mg so at least in theory he should be able to tolerate a higher dosage. How does one call attention to this issue without seeming to do so?

Thanks,  Cheryl

Hello Cheryl,

Thanks for your question. As you know, I’m not a doctor.  But 40mg of Lamictal is so low I’m surprised it’s working at all.  We are all different of course- but when the therapeutic dose of Lamictal is 200mg, it makes sense to get close to that to see how much the Lamictal can really help.  My coauthor Dr. John Preston is a psychopharmacology expert and he agrees! My mom is on 150 mg and my brother is on 300 mg. I am on 700 mg.  (Yes, 700 mg.) We are all getting huge benefits from the Lamictal. If your boyfriend were stable,  then it wouldn’t  matter what the dose is- but since he is having symptoms,  the dosage needs to be examined!

Regarding how to talk with him. I believe in a very direct approach. If you can’t talk to him about his meds, it will be hard on you to always have to tip toe around the topic.  I teach all of my clients to talk directly with their loved ones- BUT there is a certain way you have to do it. I call the following example  a script. This means you stick to it and use a tone of voice that is loving, light and yet firm.

Here is what I would say:  I know that you and your doctor are trying to take things slowly. This usually means a few months at a time to increase a dose.  Lamictal only works well when it’s at a therapeutic dose.  All of the research shows that Lamictal works at around 200 mg. I know that you are working so hard to manage this illness. I’m really proud of you! I want the meds to make a difference.  It will never hurt to try a higher dose and you can go from there.

I know you like your doctor and he wants to make sure you’re ok, but you’re also a part of this. It’s about team work. I have heard that Lamictal helps with depression, but it also calms down anger, rapid cycling, hypomania and sleep troubles.   (I read it on Julie’s blog and she knows first hand!) I want to work with you on this. A lot of people don’t know that Lamictal helps a lot more than depression. I want you to be as stable as possible because I love you!

Go for it Cheryl!

Julie