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Lamictal (lamotrigine) for bipolar disorder: What to know

Lamictal (lamotrigine) for bipolar disorder: What to know

Reviewed by:
Susan Kim, MD
|
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June 18, 2024
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Key takeaways

  • Lamictal is an antiseizure drug that's also approved to treat bipolar 1 disorder .
  • Your doctor may prescribe in conjunction with other mood stabilizer medications.
  • It's typically not used for just depression, but may work in certain situations.
  • Side effects include dizziness, tremors, and back pain, but not weight gain
In this article

If you have bipolar disorder and struggle with manic and depressive mood episodes, you might be curious about medications that manage your symptoms. There are various prescription medications that can effectively treat bipolar disorder, reducing symptoms and preventing severe “highs” of mania and “lows” of depression.

One commonly prescribed medication for bipolar disorder is Lamictal, the brand name for lamotrigine. Although the medication is an anticonvulsant, or antiepileptic drug, it’s also useful for mood stabilization.

Read on to learn about what Lamictal treats, how it works, side effects, risks, and more.


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What conditions can it treat?

Lamictal is FDA-approved to treat two conditions: epilepsy and bipolar disorder.  

  • Epilepsy: Lamictal can be used as an adjunct (add-on) treatment for individuals 2 years and older with certain types of seizures. Or, it can be used as a monotherapy for people 16 years and older with certain types of seizures.
  • Bipolar disorder: Lamictal is used as a maintenance treatment for people with bipolar I disorder.  

“Maintenance treatment” refers to extending the time between mood episodes rather than relieving symptoms at the height of a manic or depressive episode. Essentially, with this maintenance treatment, there will be more time in between episodes of depression, mania, or hypomania, preventing more frequent mood swings.  

Lamictal may also be used “off-label” for uses other than what the FDA has approved it for if your doctor thinks  could be a good fit. This includes acute episodes of bipolar disorder or rapid cycling bipolar disorder.

In some cases, doctors may prescribe Lamictal for people who don’t have either bipolar disorder or epilepsy. Additional uses of Lamictal include:

  • Schizophrenia
  • Fibromyalgia
  • Basilar migraine with aura
  • Panic disorder
  • Binge eating disorder

How does Lamictal work?

Although Lamictal is safe to take and FDA-approved, researchers don’t exactly understand the medication’s mechanism of action—or why it exactly works. One theory is that it affects sodium channels in the brain, decreasing the activity of “excitatory” neurons such as glutamate –– which can prevent seizures.  

According to the FDA, the exact way that Lamictal acts as a mood stabilizer for bipolar disorder is unknown, but it could also be due to the impact it has on excitatory neurons.  

How long does it take Lamictal to work?

If you’re taking Lamictal for bipolar disorder, you have to be patient. Although you might see some effects within weeks, it can take months to notice the full effects of lamotrigine.

Part of this is because it’s recommended to start at a low dose of Lamictal and then slowly titrate (increase the dose) over a prolonged amount of time. This helps reduce the risk of side effects.

If your doctor follows the FDA’s recommended titration regimen, you’ll start at 25 mg daily, and it will take seven weeks to reach a “therapeutic dose.” of 200 mg.  The manufacturer's recommended maximum dose is 200mg, but you may even go to 400mg if your psychiatrist recommends it.

Your dose of lamotrigine will depend on your individual response to the medication and whether you are taking any other medications that affect Lamictal.

For example, if you take Depakote (valproate), you may need a lower dose of Lamictal. Or, in other instances, you might need a higher dose of Lamictal, such as if you take:

  • Carbamazepine
  • Phenytoin
  • Phenobarbital
  • Primidone
  • Hormonal birth control containing estrogen

Tell your doctor about all medications (over-the-counter and prescription) and supplements you take.  

What happens if I miss a dose?

If you miss a dose of Lamictal, take it as soon as possible when you remember that you’ve missed it. However, if it’s very close to the time of your next dose, skip your missed dose. Do not take a double dose to try to make up for it.  

If you’re unsure if the timing is cutting it too close to your next dose, call your pharmacy or doctor to confirm whether or not you should take the missed dose.  

Common side effects of Lamictal

When taking Lamictal for bipolar disorder, you may experience side effects, especially when you first start the medication. However, this medication is usually very well tolerated.

Potential side effects of Lamictal include:

  • Dizziness
  • Headache
  • Drowsiness
  • Nausea
  • Vomiting
  • Diarrhea
  • Stomach ache
  • Insomnia
  • Dry mouth
  • Tremors
  • Vision changes  
  • Loss of coordination  
  • Back pain
  • Fever

Let your doctor know if any of these side effects won’t go away or worsen.  

Additionally, there is a risk of serious, life-threatening complications from Lamictal. These complications aren’t common, but it’s important to be aware of them and their warning signs so you can seek medical attention ASAP.

  • Stevens-Johnson syndrome: This is a potentially fatal complication that includes a very serious rash. It may start with cold or flu-like symptoms and a fever and then cause a blistering rash. If you notice any type of skin rash when taking Lamictal, tell your doctor right away. The medication can cause a benign rash unrelated to Stevens-Johnson, but in rare cases, the rash could be very dangerous.  
  • Suicidal thoughts or behaviors: There’s an increased risk for worsening depression, including new or worsening thoughts about suicide or self-harm. Contact your psychiatrist immediately if you start to feel worse after starting Lamictal.
  • Aseptic meningitis: This is another rare but dangerous complication of Lamictal. Signs include headache, nausea, vomiting, and fever. One tell-tale sign of meningitis is pain when you try to move your neck or turn your head. This can occur anywhere from one day to one and a half months after starting medication.
  • Multiorgan hypersensitivity reactions/drug reaction with eosinophilia and systemic symptoms (DRESS): This is when your body has a dangerous hypersensitivity reaction to the drug. Signs include fever, rash, and swollen lymph nodes.  
  • Blood dyscrasias: This refers to blood diseases or disorders. Look out for abnormal bleeding, infections, or signs of anemia (like shortness of breath or weakness).

Again, these serious risks are very rare, so don’t panic. It’s just important to be aware of risks and warning signs to look out for when you start Lamictal, just in case. Call your doctor immediately if you have any of these side effects.  

Does Lamictal cause withdrawal?

It’s not common for Lamictal to cause withdrawal symptoms in people with bipolar disorder –– however, if the drug is abruptly stopped, there is a small possibility of having a seizure.

You should only stop taking Lamictal if your doctor advises you to do so. Your doctor will likely recommend a slow and steady taper of the medication over the course of two weeks.  

Does Lamictal cause weight gain?

Lamictal generally does not cause weight gain. In clinical trials, less than 5% of participants taking Lamictal experienced weight gain. Additionally, a study looking at Lamictal patients' weight over the course of a year found that weight stayed stable throughout a year of taking the medication.  

So, you shouldn’t have to worry about weight gain with Lamictal. However, individual responses to medication vary, and it is possible, although not likely, that you could gain weight due to Lamictal.  

Can you take Lamictal when pregnant?

If you’re pregnant or planning on getting pregnant soon, it’s important to discuss this with your psychiatrist and OB/GYN before taking Lamictal.

Lamictal is a Pregnancy Category C drug. This means that there are possible risks of taking Lamictal while pregnant, but there isn’t any concrete evidence from human studies. Based on animal studies, Lamictal may cause harm to the fetus. In cases where the benefits of managing your mental health condition outweigh the potential risks to the developing fetus, your doctors may decide it’s okay for you to take the drug while pregnant.  

Additionally, if you’re planning on breastfeeding, it’s important to know that Lamictal gets passed into breast milk, which can have negative effects on the baby. Discuss this with your OB/GYN and/or the baby’s pediatrician to determine the best course of action.

Is Lamictal right for me?

If you have been diagnosed with bipolar I disorder, Lamictal could be the right fit for you. This medication is proven to be effective and well-tolerated for many people. Ultimately, a psychiatrist will be your best guide to confirm your diagnosis and help you determine which drug is the best fit for you, whether or not it’s Lamictal.  

If you’re looking for a psychiatrist, consider Talkiatry. We’re a national psychiatry practice that treats a variety of mental health conditions, including bipolar disorder.  We provide virtual, in-network services so you can get the care you need from home. To get started, complete our free online assessment to get matched with a psychiatrist.

FAQs

Can you take Lamictal for depression?

Yes, you can take Lamictal for depression. However, this is an off-label usage, meaning the FDA has not approved Lamictal specifically for treating major depressive episodes. However, your psychiatrist might determine that Lamictal could be a good option for treating depression if you haven’t responded to first-line depression treatments, such as SSRI or SNRI antidepressants.

What kind of medication is Lamictal?

Lamictal falls under the umbrella of anticonvulsants or antiepileptic drugs. Although it’s an anti-seizure drug, it has mood-stabilizing properties, which is why it’s beneficial for the treatment of bipolar disorder.

What are alternatives to Lamictal?

If you have bipolar disorder, there are various other medications you can take, including:

  • Mood stabilizers, like lithium or Depakote (valproate)
  • Atypical antipsychotics such as Risperdal (risperidone), Abilify (aripiprazole), or Latuda (lurasidone)

Your doctor will decide the best course of action for you.  

The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

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About
Susan Kim, MD

Dr. Susan Kim is a board certified psychiatrist who was born and raised in Queens, NY.  She has spent much of her time in the North East and is currently residing in New Jersey with her spouse and dog, Luna. Dr. Kim began her medical training at Temple University in Philadelphia, completed her psychiatric residency at Stony Brook University Hospital where she was chief resident for her final year. She has worked in numerous psychiatric roles.  This includes working at a Comprehensive Psychiatric Emergency Program (CPEP) at Stony Brook University Hospital, as well as the inpatient voluntary psychiatric unit at Holy Name Hospital.  She has also worked as a psychiatric consultant for patients admitted to medical-surgical units at Holy Name Hospital.

Dr. Kim is well versed in medication management, particularly for depression, anxiety, as well as psychotic disorders. Her treatment style includes several psychotherapeutic techniques including supportive, cognitive behavioral, and psychodynamic based on her patient's needs and preferences. She also holds a special interest in cultural psychiatry as well as relational intelligence.

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