Lamictal (lamotrigine): uses, side effects, and what to expect

If you or your psychiatrist are considering Lamictal, you probably have questions about how it works, what it treats, and what to expect. Lamictal (lamotrigine) is a mood stabilizer in the anticonvulsant class, most commonly used to help manage bipolar disorder and seizure disorders. It is especially known for helping prevent depressive episodes in people with bipolar disorder.

Key takeaways

• Lamictal (lamotrigine) is a mood stabilizer used to treat bipolar disorder and seizure disorders.
• It works by calming overactive nerve signals and reducing excess glutamate, a stimulating brain chemical.
• Lamotrigine is started at a low dose and increased gradually over several weeks to reduce the risk of a rare but serious rash.
• It is not a controlled substance, and it is generally well tolerated compared to some other mood stabilizers.

What is Lamictal?

Lamictal is the brand name for lamotrigine, a medication in the anticonvulsant (mood stabilizer) class. It is FDA-approved for bipolar disorder and seizure disorders. Lamotrigine is one of the most commonly prescribed mood stabilizers because of its favorable side effect profile and its effectiveness at preventing depressive episodes.

What does Lamictal treat?

Lamotrigine is prescribed for several conditions. Your psychiatrist will determine whether it is appropriate based on your symptoms, history, and treatment goals.

On-label uses

• Bipolar disorder, particularly for preventing depressive episodes¹
• Seizure disorders (epilepsy)¹

Off-label uses

Psychiatrists sometimes prescribe medications off-label, meaning for a use not specifically approved by the FDA but supported by clinical experience. Lamotrigine may be used off-label for:

• General mood instability not meeting full criteria for bipolar disorder
• Treatment-resistant depression

How does Lamictal work?

Lamotrigine works by quieting overactive electrical signals in the brain. Think of it as turning down the volume on nerve cells that are firing too intensely, which helps smooth out mood swings and prevent seizures over time.

• Stabilizes overactive nerve signaling. Lamotrigine helps regulate electrical activity in the brain by affecting sodium channels in brain cells.^{1 2}
• Reduces excess glutamate release. Glutamate is a stimulating neurotransmitter, and lowering its activity may help prevent extreme mood shifts and seizures.²
• Helps stabilize mood over time. These combined effects can reduce depressive episodes and help maintain more consistent mood in people with bipolar disorder.¹

3 things a Talkiatry psychiatrist wants you to know about Lamictal

• It must be started slowly. Your doctor will gradually increase the dose over several weeks. This slow titration is necessary to reduce the risk of a rare but serious skin reaction.¹
• Watch for new rashes. A rare but serious skin reaction can occur, especially in the first few weeks. Any new rash should be reported to your clinician right away, even if it seems minor.^{1 2}
• It helps prevent mood episodes, not stop them mid-swing. Lamotrigine is especially helpful for preventing bipolar depression and works best as a long-term maintenance medication. It is less effective for treating acute mania, so a separate medication may be prescribed to manage manic or mixed episodes.

Common side effects of Lamictal

Most side effects of lamotrigine are mild and may improve as your body adjusts to the medication. Common side effects can include:¹

• Loss of balance or coordination
• Double vision or blurred vision
• Uncontrollable eye movements
• Difficulty thinking, concentrating, or speaking
• Headache
• Drowsiness or dizziness
• Diarrhea or constipation
• Loss of appetite and weight loss
• Heartburn, nausea, or vomiting
• Dry mouth
• Stomach, back, or joint pain
• Tremors

Talk to your psychiatrist if any of these feel persistent, severe, or get in the way of your day.

Serious side effects of Lamictal and when to seek help

Serious side effects are uncommon but require immediate medical attention. Contact your psychiatrist or seek emergency care if you notice any of the following:¹

• Rash, blistering or peeling skin, hives, itching, or painful sores in your mouth or around your eyes (serious rashes usually develop in the first 2 to 8 weeks but can occur at any time)
• Swelling of your face, throat, tongue, lips, or eyes, along with difficulty swallowing, breathing, or hoarseness
• Seizures that happen more often, last longer, or feel different from previous seizures
• Symptoms resembling meningitis: headache, fever, nausea, vomiting, stiff neck, sensitivity to light, chills, confusion, and muscle pain
• Unusual bleeding or bruising
• Fever, rash, swollen lymph nodes, yellowing of skin or eyes, abdominal pain, or painful or bloody urination
• Chest pain, muscle weakness, or muscle pain
• Signs of infection: sore throat, fever, chills, cough, difficulty breathing, ear pain, pink eye, or frequent or painful urination
• Heart rhythm changes: racing, skipped, or slow heartbeat; shortness of breath; dizziness; or fainting

Call your psychiatrist right away or seek emergency care if you experience any of these symptoms.

What to watch for when starting Lamictal

When you first begin taking lamotrigine, your dose will start low and increase gradually over 1 to 2 week intervals. This slow approach is designed to reduce the risk of a serious rash, which is most likely to develop in the first 2 to 8 weeks. Children ages 2 to 17 have a higher rash risk than adults.¹

Drowsiness or dizziness may occur, so avoid driving or operating machinery until you know how the medication affects you. Your mental health may also shift during the early weeks. Watch for panic attacks, agitation, restlessness, new or worsening irritability, anxiety, or depression. Let your psychiatrist know if you notice aggressive behavior, difficulty sleeping, mania, or thoughts of self-harm.¹

If you are breastfeeding, monitor your baby for unusual sleepiness, interrupted breathing, or poor sucking.¹

What to do if you miss a dose of Lamictal

If you miss a dose, take it as soon as you remember. If it is almost time for your next scheduled dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a missed one.¹ If you miss more than 3 days of doses, contact your psychiatrist before resuming. You will likely need to restart at a lower dose to reduce the risk of rash.

Who should talk to a psychiatrist before taking Lamictal

Some health conditions, medications, and life situations change how Lamictal is prescribed. Tell your psychiatrist if any of the following apply to you:¹

• You have an allergy to lamotrigine or other epilepsy medications
• You take valproic acid or divalproex (these increase the risk of a serious rash)
• You have had a rash after taking lamotrigine or other epilepsy medications
• You have an autoimmune disease such as lupus
• You have a blood disorder
• You have depression, mood problems, or suicidal thoughts or actions
• You have heart failure, irregular heart rhythms, or other heart disease
• You have kidney or liver disease, or ascites
• You are pregnant or planning to become pregnant
• You are breastfeeding
• You take hormonal contraceptives (lamotrigine may reduce their effectiveness)