I have seen references to emotional flattening in relation to prozac and mood stabilizers such as depakote (at your site and elsewhere). I feel this way about lamictal.  I think it seems to protect against the worst of the worst, but at the same time, keeps me below my own baseline.  That surprised me coming from a drug that is supposed to work on the depression end of things( esp. in someone who doesn't get hypomanic to begin with). It was going off this medication that it became very obvious.  Have you seen this in other patients with lamictal?

Thanks much,


Dear Ms. C. --

You raise an important question. Frankly, I am not sure I have ever seen such a reaction to lamotrigine (Lamictal). Unless, however, we include one other phenomenon: sometimes there is some confusion about where the true "prior baseline" really was. For people with relatively mild hypomania, who were having rapid cycling, sometimes people think that the hypomanic phase is the baseline (with repeated episodes of depression, going down from that baseline, then returning). Obviously, under those circumstances, a "mood stabilizer" that stops the cycling could easily leave a person feeling stabilized "below the baseline".

In your case, it would be important not to assume that this explanation applies -- only to consider it. If another medication seemed to have the same effect, this explanation might actually have some value. 

Otherwise, since the effect seemed to go away when the medication was removed, it would certainly seem that Lamictal was the culprit. Your letter will help me keep my eyes open for this possible effect in others. Thank you.

Dr. Phelps



Published January, 2008