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I am on lamictal and am an adult.  I had a toxic reaction at 200 mg and taking it for two years. It gave me an eye condition, nystagmus. It was reduced to 100 mg.  I am on lexapro (20mg) and wellbutrin (200).  I feel better. I would not take him off lamictal until your pychiatrist says so.  I am not a doctor, but 400 mg seems like an awful lot!  I never heard of being on that much....particularly for a child.  Perhaps tell your doctor you want him to come off it.  He should take him off gradually because coming off any med for bipolar, or any mood disorder, can have some terrible withdrawal effects.  Also, if your child is throwing up, he is definetly having a bad reaction, or perhaps the dosage is making him toxic.  Please talk to your doc.  If he tells you to keep him on it at that dosage, I would get another opinion.  What kind of symptoms of bipolar does your son have?   raku