how does lamictal work for anxiety

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This FDA-approved medication prevents bipolar disorder mood episodes and is different from other mood stabilizers in that its effectiveness against depression is greater than that of mania.


Lamotrigine (Brand names: Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR)

Lamotrigine, like other mood stabilizers, was initially developed to treat seizures. It is commonly used in conjunction with other medications for bipolar disorder (manic-depressive). Psycom interviewed Joseph Goldberg MD, Clinical Professor of Psychiatry, at the Icahn School of Medicine, Mount Sinai, New York. He is also co-author of Managing Side Effects of Psychotropic Medications 2nd Ed., a textbook published in the American Psychiatric Association Publishing. Christopher Aiken, MD is the director of North Carolina’s Mood Treatment Center.

Dr. Aiken says that Lamotrigine, the only mood stabilizer, calms mood swings and lifts depression instead of suppressing manic symptoms. It is a great choice for bipolar patients, as the depressive symptoms often outweigh those of manic depression. Its greatest benefit lies in prevention. It is able to prevent depressive and manic symptoms, but it has more benefits for depression.

Dr. Aiken says that patients love lamotrigine because it is generally free from side effects. In the original research, people experienced more side effects with lamotrigine than with the placebo. Although it may seem impossible, it is likely that lamotrigine helped people feel better by treating their depression,” says the expert in mood disorders. He also explained that lamotrigine is largely free from the “medicated” feelings many people associate with mood stabilizers. People don’t feel dull, flat or groggy when they take lamotrigine.

Some research studies that compared placebo with medicine produced remarkable results. He explains that Lamotrigine is the only medication we know of that patients couldn’t tell they were taking it. It didn’t make patients feel sick, and the benefits accumulated slowly. People who took lamotrigine for 2 years had half the days of depression than those who didn’t.

What conditions can be treated with lamotrigine

Although lamotrigine is not considered an antidepressant, it is used as a maintenance treatment for bipolar I disorder to help stabilize mood changes. Manic episodes are a hallmark of bipolar I disorder. 1,2

Dr. Goldberg recalls that the original bipolar depression studies by Dr. Goldberg on lamotrigine showed stronger improvements in bipolar I than in bipolar II. (Bipolar II disorder is characterized by longer episodes and more frequent occurrence of major depression and hypomania.) Newer research suggests, however, that lamotrigine maybe even more effective as a mood stabilizer in preventing relapses in treating bipolar II disorder.2

There are also conditions lamotrigine treats off-label including borderline personality disorder, schizoaffective disorder, and obsessive-compulsive disorder (OCD), Dr. Aiken says.

What is the working principle of lamotrigine?

Bipolar disorder sufferers may experience a delay in mood changes or manic or depressive episodes. Lamotrigine decreases the brain’s irregular electrical activity, which can cause mood swings and depression. Bipolar disorder sufferers are more likely to experience recurrent or relapsing mood changes. These relapses and recurrences can be prevented or delayed by taking lamotrigine as a maintenance treatment.

Dr. Goldberg says that many clinicians believe lamotrigine can help achieve and sustain all moods over time due to its antidepressant (mood-stabilizing) properties. “It works with mood stabilizers like lithium and Divalproex, but it’s not interchangeable with these drugs and cannot be used in their place.”

Lamotrigine can be used as preventative medicine. Lamotrigine is used as a preventative medication.

Is there a standard dose of lamotrigine in the body?

Initially, your doctor will prescribe a low dose. Then, gradually increase the dose each week for several weeks until you reach an effective level.

Dr. Goldberg points to the fact that “target blood levels for lamotrigine treatment have not been established for other conditions than epilepsy.” According to Dr. Goldberg, 200 mg/day was determined to be the best target dose for relapse prevention. However, higher doses (400 mg/day), did not offer greater protection against relapse.

The dosage of lamotrigine will depend on the medications you take to treat bipolar disorder. It can be adjusted as you stop taking other medications or wean off.

Dr. Goldberg notes that some medicines slow down lamotrigine’s metabolism (notably Divalproex), which requires a slower rate and a lower target dosage. Other medicines speed up the metabolism of lamotrigine (notable carbamazepine), which requires a faster dose increase and a higher target dose.

There are many forms of lamotrigine available for bipolar disorder treatment: tablets, chewable tablets, and dissolving tablets. You may be told by your doctor to take the tablets one time a day, twice daily, or every other day.

Do not miss a dose. Take the missed dose as soon you remember. You can skip the missed dose if it is near the time of your next dose. Never take more than one dose of lamotrigine.

What is the average time it takes to get to work?

Dr. Aiken says that in some cases the antidepressant effects and antimanic properties of lamotrigine can be noticed very early in the treatment process. For some patients, however, the effects of lamotrigine can be seen within a few months. However, there will always be patients who take longer to see the positive effects.

Lamictal/Lamotrigine Cost

If you order 100 tablets of medication, the pricing breakdown for one tablet is as follows: (Note – pricing information generated April 2011,)

  • $25.83 for 25 mg tablet
  • For 100 mg tablets, $5.43
  • For 150 mg tablets, $5.93
  • $5.67 for 200mg tablet

The generic cost of lamotrigine (lamotrigine), is as follows:

  • $0.3 per 25 mg tablet
  • $0.3 per 100mg tablet
  • $0.53 per 150 mg tablet
  • $0.53 per 2000 mg tablet

Lamotrigine has many advantages

Dr. Aiken explains that lamotrigine has several major benefits, including:

  • It is effective for a majority of bipolar patients
    Nearly two-thirds (63%) of bipolar patients have experienced remarkable results from lamotrigine.
  • It is ideal for mixed states
    When given in therapeutic doses, lamotrigine has been well-received by people who have suffered from mania switches caused by intense cycling.
  • Patients who have no other options for treatment will benefit from it.
    Lamotrigine has been shown to be effective in treating patients who have failed to respond to other mood stabilizers or lithium.
  • Side effects are very rare
    Lamotrigine is a mild, non-sedating drug that can usually disappear after a while.

Who can and cannot take lamotrigine to treat bipolar disorder?

Adults and adolescents may be prescribed lamotrigine by their doctors if they are being treated for bipolar disorder. Lower doses may be prescribed for older adults who are more sensitive to lamotrigine’s effects. People who respond to lamotrigine often report that they are able to see the big picture and are less reactive to stress. Although they may still experience depression occasionally, these days are usually shorter and less frequent,” Dr. Aiken says.

If lamotrigine is given too quickly, children under 18 years old are more likely to develop a skin rash. Dr. Goldberg says that lamotrigine can be used to treat bipolar disorder in youth, despite the possible side effects.

Although no definitive information is available about lamotrigine’s safety during pregnancy, Dr. Goldberg said that many doctors consider it one of the safest options for women with depression or mania. Lamotrigine, like many psychotropic drugs is secreted in breast milk. Women are advised to talk with their doctors about the risks and benefits of breastfeeding while on lamotrigine.

Lamotrigine Side Effects

People who take lamotrigine might experience side effects or adverse reactions. Lamotrigine can cause severe, potentially life-threatening skin reactions in approximately 8 out of 10,000 people. This usually occurs between the second to eighth weeks of treatment. Higher starting doses, higher escalating dosages, and lamotrigine combined with valproate increase the risk of developing a rash. Both bipolar I and II patients who were treated with lamotrigine in the early clinical trials and subsequent research found that there was an overall increase of skin disorders between 11 and 12%. 2

Dr. Goldberg stresses that most of these skin problems are harmless. Dr. Goldberg emphasizes that serious rashes caused by lamotrigine are not an allergic reaction, but a systemic reaction, which often includes fever, sore throat, and swelling glands.

Dr. Goldberg warns that allergic reactions can occur to lamotrigine, as with all medications. If you experience symptoms such as hives or facial swelling or difficulty breathing, get immediate medical attention. If you notice a skin rash on your skin, particularly if it appears in your mouth, around your eyes, or around your nose, or if it causes blistering, peeling, or burning sensations, consult your doctor immediately. Medical staff should be notified of any medications that you take.

Side effects can be serious and should be reported to your doctor immediately.

  • Skin rash, blistering, or peeling
  • Painful (or burning) sores around the mouth, eyes, or genitals
  • Jaundice is yellowish skin and eyes.
  • Swollen gland, fever, severe muscle pain
  • Drowsiness, weakness, and confusion
  • Headache and stiff neck
  • Sensitivity to light has increased
  • Changes in mood or behavior, such as depression or anxiety, hostility, hostility or restlessness, mental hyperactivity, suicidal thoughts, or agitation.

Side effects of lamotrigine which aren’t emergencies should be reported to your doctor.

  • Headache or dizziness
  • Double vision or blurred vision
  • Dry mouth
  • Gastrointestinal distress, such as nausea, vomiting or diarrhea, can cause stomach pain.
  • Fever, sore throat, runny nostrils
  • Drooling or fatigue
  • Tremor
  • Insomnia

Lamotrigine Rash

The biggest risk with lamotrigine is a rare allergic reaction called Stevens-Johnson Syndrome, which can be fatal if left untreated. This reaction can be caused by many medications, including penicillin and antibiotics like Bactrim. These precautions can help to prevent the risk of developing a rash:

  1. It is important to increase the doses slowly.
  2. If you notice any skin changes or rash, it is best to stop the medication immediately. After 3 months, the risk of Stevens-Johnson Syndrome drops to almost zero
  3. Avoiding false-alarm rash confusion by not using new soaps, sunburns, poison ivy, or starting any new medication within the first three months after starting lamotrigine.

These steps reduce the chance of severe rash to 1 in 3,000. Without them, it is closer to 1 in 100. Dr. Aiken says that there is still a risk of benign, non-serious rashes (5% chance). Therefore, many people must stop taking lamotrigine. It may be possible to resume lamotrigine at a lower dose if you have stopped responding to the drug due to a rash.

Is lamotrigine compatible with other medications?

Other drugs may affect how lamotrigine is absorbed by your body. These drugs include hormone treatments, hormonal birth control, hormone treatments, seizure medication such as phenobarbital and valproic acid, which can also be used to treat bipolar disorder.

When lamotrigine is used in combination with other medications, your doctor will monitor and prescribe the dosage. Take lamotrigine with caution. Avoid alcohol, cannabis, or any other substance that may cause dizziness. Before taking lamotrigine, talk to your doctor about any other medications you take or substances that can affect your mind.

One recent British study found that folic acid supplements can cancel out lamotrigine’s benefits (Geddes et al., 2016). Dr. Aiken says that no one expected this result as folic acid is known to help depression and other medications like valproate (a mood stabilizer approved for mania-associated mit bipolar disorder, seizures/epilepsy, and migraine headaches). We need to do more research before we can trust this result. However, until then we recommend that you take lamotrigine as is, without any folic acids supplements, even multivitamins. If you decide to supplement with folic acid after you have been doing well on lamotrigine.

Is it okay to stop taking lamotrigine suddenly?

Consult your doctor before stopping lamotrigine. Do not stop taking lamotrigine for longer than 7 days. Talk to your doctor about your dosing regimen



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