Can Lamictal Cause a Mixed Episode?
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Q:  I am wondering if Lamictal might cause a mixed episode. I've been on it for over a year with little success and my doctor is still insistent that it will help to keep things from coming back....but things aren't going away. I really think I have been in a mixed episode for months now and am starting to blame the Lamictal.

Dear Ms. S'.  --

One does not see this in the literature at all, but I have talked with several colleagues who have used a lot of lamotrigine and we all agreed that on occasion -- perhaps one time in 20 or 30 -- lamotrigine can actually act too much like an antidepressant.  People feel somewhat agitated, more so as the dose goes up.   

For example: one of my patients was able to lower the dose to 25 mg and get a good outcome which for about six months has remained stable; at 50 mg he was better in terms of depression, no question, but a little edgy, and at 75 mg, he was worse, in a subtle way.  Otherwise, and most other people when I have seen this problem, we are had to abandon the lamotrigine (but next time, I'm going to just try turning it down to a very low level.  This one particular fellow above got a nice antidepressant effect from it, so it was a good thing -- as long as we kept the dose down). 

On the basis of all that, when I have lamotrigine in a mixture of other medications, I do actually wonder whether it could be to blame, when things are not smoothing out.  Nevertheless, this is a very uncommon problem; and because it has not really been reported in the literature, there is still a possibility that my colleagues and I are operating under a false impression.  So be careful: don't go tramping into your psychiatrist's office announcing that Lamictal is probably the problem.  It's more like the other way around: in my opinion, you can't quite say that it is not the problem.

Dr. Phelps

Published May, 2008


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