Lamictal titration for bipolar disorder; how much do you go up or down on the dosing?

Gradually. If not in a crisis situation in which quick changes need to be made, it is best to be very gradual wiht adjustments in lamictal. It is usually wise to increase the dose by 25mg at a time at low doses, and possibly 50mg at a time if already taking 200-300mg a day. A gradual increase may help protect against the skin reactions that can oocur with lamictal. Gradual decreases are best as well.