Q:  Lamotrigine Appropriate Substitute?

treatment for acute hypomania secondary to very severe head injury: 200mg lithium and 1200mg valproate. pretty much stable yet experiencing large amounts of pain and stiffness in injured hip and leg which i beleive to be the valproate. tried reducing dose but anxiety increases and cannot sleep etc. taken strong painkillers but only excerberate anxiety and result in taking higher doses of valproate.

tried lith, valp, and carb and combos and present combo seems to be best.  but this weakness and pain is forcing me to look elsewhere. is lamotrigine an appropriate substitute and what is the efficacy? due to head injury are the side effects that will be intollerable?

i hope to hear from you soon,

thanks, simon

Dear Simon -- 
Carb' not tolerated well?  did it give pain relief, though, as it sometimes does?  If not tolerated but otherwise maybe helpful, you could try Trileptal as a substitute with possibly less side effects (same med with an oxygen stuck on, maybe a little easier to take). 

Lamotrine would be okay to try as far as I know, check it with your doc'.  Remember, you have to be even more cautious than usual if you add it to Depakote (e.g. see my handout for patients, for review with your doc').  

Dr. Phelps