Bipolar Medication Spotlight: Lamictal (Lamotrigine)

By Candida Fink MD

With this post, we continue our biweekly series on medications used to treat bipolar disorder and related symptoms. This week, we focus the spotlight on Lamictal (lamotrigine) – an anti-seizure medication that has been found useful in treating bipolar disorder. Following are some of the primary benefits Lamictal offers:

• Reduces frequency of mood cycles – both depressed and manic
• It has antidepressant properties – one of the few anti-seizure medications proven effective in treating bipolar depression
• Does not typically cause fatigue or weight gain

Although most people tolerate Lamictal, it does have some drawbacks and negative side effects:

• Rare but dangerous skin reaction – characterized by hives, fever, swollen lymph glands, painful sores in the mouth or around the eyes, or swelling of lips or tongue. This is extremely rare and different than a typical drug rash. As noted below, the risk of this side effect can be reduced dramatically by starting the medication in very low doses and working up very slowly.
• Generalized allergic reactions can also occur, but rarely do.
• Most common, typically mild, effects include nausea, dizziness, blurry vision, and headache.
• Combination with Depakote can increase the blood level of Lamictal and therefore increase the risk of rash; someone taking Depakote will have to start and increase the Lamictal doses even more slowly.
• For women, taking oral contraceptives can decrease the level of Lamictal, so Lamictal doses may need to be adjusted when a woman starts oral contraceptives.
• Like all anti-seizure medications, if Lamictal is stopped too rapidly seizures can occur.
• Lamictal, like other antidepressants, rarely can cause paradoxical mood and anxiety symptoms, including suicidal thoughts.
• Lamictal is cleared through the kidneys so must be adjusted for people with kidney disease.
• Rare blood problems have been reported.

Lamictal is not used to treat acute mania. It is used as maintenance therapy to reduce frequency of cycles in Bipolar I disorder. However because of its antidepressant properties, it is increasingly being used in Bipolar II to treat the typically recurrent and severe depressive cycles, without carrying the risks of mania that may occur with other antidepressants. It is also being used more and more to treat recurrent unipolar depression – often as an augmentation strategy if antidepressants alone are not working well enough.

As noted above, to prevent serious side effects from developing, your doctor is likely to start you at a low dose and ramp up the dosage very gradually over the course of several weeks. So one downside to Lamictal is that it takes quite a while to be effective because of this process. If you’re going to have a serious reaction, it’s likely to occur during the first eight weeks of treatment.

If you experience the symptoms of a serious reaction (skin rash, fever, swollen lymph nodes, for example) while taking Lamictal, contact your doctor immediately.

For additional information on the potential benefits of using Lamictal to treat bipolar disorder and how to start your treatment, visit GlaxoSmithKline’s Lamictal Bipolar Home page. To see what others who’ve taken Lamictal have to say about it, visit Psych Central’s Rate ‘n Review Bipolar Medications bulletin board, where Lamictal has received very positive ratings.

Caution: Never stop taking any medication cold turkey, especially an anti-seizure medication. Withdrawing an anti-seizure medication too quickly can actually cause seizures. Always consult your doctor before you stop or decrease your medication.

If you’ve taken Lamictal for bipolar disorder or are a doctor who has prescribed it, please share your experiences, insights, and observations.

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