Jan 14, 2000
FAQ: Lamotrigine for Depression and/or
NOTE: Lamotrigine is only approved for the
treatment of people with seizures. There are
very few studies that establish the safety
or efficacy of lamotrigine as a treatment
for people with mood disorders and/or Borderline
Personality Disorder. While such studies are
ongoing, most of what is currently known about the
use of lamotrigine for the control of psychiatric
disorders comes from uncontrolled case reports.
is lamotrigine (Lamictal)?
is an anticonvulsant that is chemically unrelated to any other
or mood regulating medication.
was lamotrigine approved for marketing in the USA and for what
may it be promoted?
received final approval for marketing in the USDA on 27
1994 and is labeled for use as an anticonvulsant.
3. Is a
generic version of lamotrigine available?
no generic lamotrigine as the manufacturer has patent protection.
4. How does
lamotrigine differ from other mood stabilizing drugs?
differs from other mood stabilizing drugs in two major ways:
frequent effectiveness for patients who have failed to respond
or mood stabilizers;
relatively benign side-effect profile.
if anything, uniquely distinguishes lamotrigine from carbamazepine
has had been successful in controlling rapid cycling and mixed
states in people who have not received adequate relief from
and/or valproate. It also appears that lamotrigine has
more antidepressant potency than either carbamazepine or
with what sorts of mood disorders are candidates for treatment with
It is too
early to be very specific about which mood disorders are most likely
to treatment with lamotrigine. There are few published reports on
use in psychiatry. Patients with hard-to-treat bipolar syndromes
schizoaffective disorder have been treated more often than patients
unipolar disorders. Some people with such hard to
depressions have been treated with good results. Some patients
with Borderline Personality Disorder, a disorder that many
believe is a varient of Bipolar Disorder, have responded to
7. Is lamotrigine
useful for the treatment of acute depressed, manic and mixed
and can it also be used to prevent future episodes of mania and/or
use of lamotrigine was to treat people with depressed, manic and
that did not respond to existing medications. Some patients are
maintained on lamotrigine on a long term basis in an attempt to
future episodes. The effectiveness of lamotrigine as a long-term
agent is currently being established.
8. Are there
any laboratory tests that should precede the start of lamotrigine
is prescribed the patient should have a thorough medical
including blood and urine tests, to rule out any medical condition,
thyroid disorders, that may cause or exacerbate a mood disorder.
9. How is
treatment with lamotrigine initiated?
not taking carbamazepine or valproate, lamotrigine is usually
prescribed at an initial dose of 25 mg once or twice a day and the
by 25 or 50 mg every week or two.
taking valproate the initial dose of lamotrigine is often 12.5 mg/day
drug is increased by 12.5 or 25 mg every two weeks.
taking carbamazepine somewhat larger initial doses and more rapid
in dose are possible.
there any special problems prescribing lamotrigine for people taking
Tegretol, or Depakote?
between lithium and lamotrigine has not been reported.
induced enzymes that facilitate the metabolism of
Because of that, blood levels of lamotrigine are somewhat lower
taking carbamazepine than in those not taking carbamazepine.
has the ability to double plasma levels of lamotrigine. Because of
lamotrigine is started in people taking valproate, the initial dose
be approximately one-half as much as is usually initially prescribed.
is the usual final dose of lamotrigine?
as an antidepressant or as a mood-stabilizing agent the final dose
is most often between 100 and 200 mg/day. Some people
doses as high as 400 mg/day to achieve a good antidepressant effect.
should avoided in patients taking valproate because of the
effect of valproate that increases plasma levels of
and the accompanying increased risk of serious dermatological
long does it take for lamotrigine to 'kick-in?'
people notice the antimanic and antidepressant effects early in
others have to take a therapeutic amount of lamotrigine for up to a
being aware of a significant amount of improvement.
are the side-effects of lamotrigine?
a listing of lamotrigine's side effects that affected 10% or more of the
taking the drug during clinical trials and the frequency of those
in the 419 people treated with placebo in those trials:
Adverse Reactions (%)
Adverse Reaction Lamotrigine
are most noticeable the few days after an increase in dose and
side-effects are severe enough to force people to discontinue
of lamotrigine that most often causes the drug to be
is a rash. Rashes can be mild, similar to a slight sunburn, or can
severe resembling a severe case of poison-ivy. The more severe the
less likely it is that the individual will be able to continue the
ALL rashes should be reported to the physicians prescribing the
A rash is
more likely to develop when the initial doses of lamotrigine are high
lamotrigine is too rapidly started when someone is taking valproate.
It is important
that people taking lamotrigine who develop a rash immediately
their physician as there have been a few deaths in people who have
lamotrigine have any psychiatric side effects?
rarely reported side effects of lamotrigine are agitation, anxiety,
problems, confusion, depression, emotional lability, irritability,
does lamotrigine interact with prescription and over-the-counter
Only a few
interactions between lamotrigine and other drugs have been
Lamotrigine increases the plasma level of carbamazepine and its
Carbamazepine lowers the concentration of lamotrigine in the
doubles the plasma level of lamotrigine, and the level of valproate
by about 25% in people taking lamotrigine.
and primidone lower the plasma level of lamotrigine by about
with other prescription and over-the-counter drugs are not
17. Is there
an interaction between lamotrigine and alcohol?
may increase the severity of the side-effects of lamotrigine.
18. Is lamotrigine
safe for a woman who is about to become pregnant, pregnant
is has been placed in the FDA pregnancy Category C:
studies have shown an adverse effect on the fetus but there are no
studies in humans; The benefits from the use of the drug in pregnant
be acceptable despite its potential risks . . . ."
19. Is lamotrigine
safe for children and adolescents?
has been used with children and young adolescents in other
In the USA, because of the increased risk of fatal side-effects in the
lamotrigine is only approved for use in those over the age of 16.
lamotrigine be used in elderly people?
seem to handle lamotrigine similarly to younger ones. There is
experience using lamotrigine for the treatment of psychiatric disorders
21. Do symptoms
develop if lamotrigine is suddenly discontinued?
no specific symptoms that have been described following the abrupt
of lamotrigine, other than the seizures that sometimes follow
discontinuation of any anticonvulsant. Only when necessary because
of a serious
side effect, should lamotrigine be suddenly discontinued.
22. Is lamotrigine
toxic if taken in overdose?
overdoses are scarce. Two individuals who took over 4,000 mg of
survived without sequelae.
lamotrigine be taken along with MAO inhibitors?
combination has been used without any special problems.
does lamotrigine cost?
As of 3
October 1996, the per tablet cost of lamotrigine, when ordered in lots
tablets from a well-known mail-order pharmacy in the USA was:
25 mg - $1.94
100 mg - $1.94
150 mg - $2.04
200 mg - $2.14
lamotrigine be effective in people who have failed to receive benefit
use of lamotrigine in psychiatry is with people who have mood
that have not been adequately controlled by other medications.
are the advantages of lamotrigine?
seems to be effective in about two-thirds of people with bipolar
that have not responded to lithium or other mood-stabilizers.
who have not been able to tolerate any antidepressant because of
to mania or increased speed or intensity of cycling, or because of the
of mixed states, have been able to tolerate therapeutic doses of
when taking lamotrigine.
people, lamotrigine has minimal side effects and can be taken once a
are the disadvantages of lamotrigine?
has only been available for a relatively short time, it was first
in 1990, there is no information about long term side-effects. As its
people with mood disorders started even more recently, it is not
people who initially do well on lamotrigine continue to do so after
a small chance of a serious, and in some cases life-threatening, rash
in people taking lamotrigine. This side effect is more frequently
those under the age of 16 than in older persons.
should physicians prescribe, and patients take, lamotrigine, when there
regulating medications that have been available for many years and
been shown to be effective in double-blind placebo-controlled
two major reasons why physicians prescribe and patients take
rather than conventional, better established drugs. They are that
benefits from treatment with the older, better known drugs, and
patients find the side effects of the established drugs to be
29. Is lamotrigine
available in countries other than the USA?
is currently available in about 60 countries.
anything been published on the use of lamotrigine as a therapeutic
people with mood disorders?
some bibliographic references on the use of lamotrigine for the
of people with mood disorders:
& Raskind J
Health Syst Pharm 1999, 56, 1939-1944. Gabapentin and lamotrigine
JR, Bowden, CL, Sachs GS, et al.
of Clinical Psychiatry 1999, 60, 79-88.
placebo-controlled study of lamotrigine monotherapy in
with bipolar depression.
JR, Bowden CL, Susan L. McElroy SL, et al.
Journal of Psychiatry 1999 156: 1019-1023.
of Activity of Lamotrigine in Treatment-Refractory Bipolar
JR, Fatemi SH, Woyshville MJ
Journal of Psychiatry 1996, 153, 1236.
effects of lamotrigine in rapidly-cycling bipolar disorder.
JR, Rappoprt DJ, Shelton MD, et al.
1998, 38, 185-191.
studies on the use of lamotrigine in bipolar Disorder.
A, Walden J, Grunze H
1998, 38, 204-205.
in the treatment of schizoaffective disorder.
AB, Weisbrot DM, Saracco J, et al.
1998, 39, 874-877.
and negative psychotropic effects of lamotrigine in patients with
and mental retardation.
Rappoport DJ, Calabrese JR, Thuras P
of Clinical Psychiatry 1997, 58, 522-527.
in rapid cycling bipolar Disorder.
1998, 38, 192-197.
and gabapentin. Alternatives in the treatment of bipolar
DL, Sternbach H
of Clinical Psychiatry 1997, 58, 271-273.
in treatment of refractory bipolar disorder.
Therapies in Psychiatry Newsletter 1997, 20, 21-24.
in bipolar and other psychiatric disorders.
& Simpson PM
Psychiatry 1999, 46, 1711-1712. The efficacy of lamotrigine in rapid
and non-rapid cycling patients with bipolar disorder.
KR & Gerner R
1998 7, 163-165.
toxicity secondary to sertraline.
& Yerevanian BI
1998, 31, 35.
effective for treatment-refractory mania?
& Matar MA
Neuropharmacology 1998, 21, 65-67.
in the treatment of resistant bipolar disorder.
V, Yatham LN
Journal of Psychiatry 1997, 154, 1171-1172.
treatment of rapidly cycling bipolar disorder.
V, Yatham LN
Research 1997, 19, 145-148.
study of lamotrigine in refractory bipolar depression.
LA & Rubey RN
Journal of Psychiatry 1997, 154, 1317.
for treatment-refractory bipolar disorder.
of Pharmacotherapy 1999, 33, 864-867. Lamotrigine---An efective mood
Journal of Psychiatry 1999, 156, 1833.
lamtrigine treatment fro major depression.
Kuzniecky R, Ho S, et al.
1999, 15, 321-327.
side effects of topiramate, gabapentin, and lamotrigine in healthy
& Akiskal HS Journal of Affective Disorders 1998, 51, 333-343.
as a promising approach to borderline personality: An open case
without concurrent DSM-IV major mood disorder.
Frye MA, Denicoff KD, et al.
1998, 19, 206-219.
lithium in the treatment of bipolar illness.
Leverich GS, Denicoff KD, et al.
and Anxiety 1997, 5, 275-189.
approaches to refractory depression in bipolar illness.
Fazeli A, McKay BG et al.
of Clinical Psychiatry 1999, 60, 708-709 Lamotrigine as prophylaxis
DJ, Calabrese JR, Clegg K et al.
Psychiatry 1999, 6 (4), 41-42.
in unipolar major depression. <
of Clinical Psychopharmacology 1997, 17, 185-189.
lamotrigine in treatment-resistant manic-depressive illness.
Neurol Psychiat 1996, 63, 320-335.
old and new anticonvulsants in treatment of psychiatric diseases.
Hesslinger B, van Calker D, Berger M
1996, 29, 193-195.
of lamotrigine to valproate may enhance efficacy in the treatment of
Xie X &
1998, 38, 119-130.
and molecular actions of lamotrigine: Possible mechanisms of efficacy
LN, Kusumakar V, Parikh SV, et al.
Journal of Psychiatry 1997, 42 (Suppl 2), 87S-91S.
depression: Treatment options.
additions and corrections to:
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