by Devin Fleharty
Snapshot of Benefits, Risks, and Possible Side Effects
| Uses | -Introduced as an anti-seizure medication in 1994 -Approved for Use in Bipolar Depression in 2003 -Prevention and treatment of depressive episodes in: –Bipolar I Disorder –Bipolar II Disorder -Off-Label use: –Treatment of Resistant Unipolar Depression –Treatment of Borderline Personality Disorder |
| Pros | -Effectively prevents future depressive episodes -Relief from depressive episodes -Can be taken in conjunction with other medications for Bipolar Disorder -Minimal if any sexual side effects -Minimal if any effects on weight -No blood tests required routinely -No metabolic side effects (no change in blood sugar or cholesterol) |
| Cons | Mild/Common -Nausea -Benign, mildly itchy Rash (3%) Rare/Severe (contact your doctor!) -Rash –Involving mucus membranes & associated with fever –Chance is 1 in 4000 people who take the medication –Happens slightly more often in people of Asian heritage –Only reported during the 30-60 days following lamotrigine initiation or dose increase. –Increased risk if you do not titrate the dose up slowly or if restarting at a high dose after 4-5 days of not taking the lamotrigine. -Heart palpitations -Allergic reaction involving swelling of tongue, lips, or throat -Increase in anxiety and/or suicidal ideation |
LAMOTRIGINE HISTORY & USE:
Lamotrigine (Lamictal) is a medication that has a variety of uses: the drug was introduced in 1994 as an anticonvulsant and anti-seizure medication, but thereafter has also been found to be particularly effective in preventing depressive mood episodes in the treatment of Bipolar I and Bipolar II Disorder. It is important to note that lamotrigine has not been shown to reliably decrease the occurrence of manic or hypomanic episodes, and has been in some cases observed to sometimes increase their occurrence.
Lamotrigine works by inhibiting the release of glutamate (an excitatory amino acid and neurotransmitter) from cells in the brain, and by stabilizing the membranes of these cells.
Your psychiatrist might discuss the possibility of adding lamotrigine to your treatment regimen if you have recurrent depressive episodes that interfere with your daily life, or if you have not found relief from other medications to treat Bipolar Disorder. Lamotrigine can be used alone to treat bipolar disorder or in conjunction with other mood-stabilizing or antipsychotic medications. We have a list of these, with pros, cons, and side effects explained here and here on our website.
POSSIBLE SIDE EFFECTS:
While lamotrigine has many uses and has found widespread success with many patients, there are some common as well as rare side effects to be aware of:
Lamotrigine has been linked to skin rashes ranging from mild to severe in about 3-5% of patients who have been prescribed the medication. In very rare cases, about 0.8-0.13% of patients may develop Stevens-Johnson Syndrome (SJS), in which the upper layers of the skin may peel off and must be treated in a similar fashion to a burn. The risk of this rare side effect is increased if lamotrigine has been prescribed to the patient along with other medications for Bipolar Disorder, such as valproate (brand name: Depakote). The risk of this rare side effect is also increased in patients who are children, immunocompromised, or have specific genetic profiles: your prescribing physician may request a genetic test or blood test from you to screen for possible alleles (genetic markers) that may increase the risk of these kinds of side effects before prescribing you this medication. These alleles are more common in individuals of Asian heritage.
Other possible side effects of lamotrigine can include irregular heart arrhythmias (when heartbeats come at an irregular pace), hives or itching, and the swelling of the tongue, lips, or throat. If you have been prescribed lamotrigine and observe the development of rashes, chest tightness, or trouble breathing, immediately get into contact with your prescribing physician or psychiatrist. This is even more imperative if you notice these symptoms during the first 2 months of treatment with the medication.
ADVANTAGES OVER OTHER MEDICATIONS:
While the side effects of lamictal are important to be aware of, we cannot discount the effectiveness of the drug in giving Bipolar patients relief from recurring mood episodes, especially in comparison to other available medications. Lamotrigine, unlike many other medications commonly prescribed for Bipolar Disorder, has no effect on weight, and only needs to be taken once daily. The medication comes in a variety of immediate release and extended release formulations, and can be taken as a chewable tablet, oral capsule, or under-the-tongue dissolving tablet. The incidence of sexual side effects is essentially none.
Discussion of past medical and treatment history with your psychiatrist, and careful attention to dosages is extremely important to take into account when considering taking this medication. As changes in dosage can have a profound effect on the risk of side effects with lamotrigine, it is important to always remember to consult your prescribing physician or psychiatrist before making dosage changes.
REFERENCES
Dulcan MK & Ballard RR. (2015). Helping Parents and Teachers Understand Medication for Behavioral and Emotional Problems, Fourth Edition.
Freerksen S, Fasano E, Grenoble S. Toxic Epidermal Necrolysis Caused by Lamotrigine: How to Counsel Patients About Risk. American Psychiatric Association Annual Conference; 2014 May 3; New York, NY. Abstract No. NR2-51