Lamictal for depression

Lamictal (lamotrigine) is a prescription drug that was approved by the U.S. Food and Drug Administration (FDA) in 1994. Lamictal can be used to treat certain types of epilepsy or seizure disorders, including partial-onset seizures, primary generalized tonic-clonic seizures, and generalized seizures of Lennox-Gastaut syndrome. Lamictal can also be used as a mood stabilizer and long-term treatment in people with bipolar I disorder. 

Bipolar I disorder is a medical condition also known as manic-depressive disorder. It causes episodes of mania (an extremely excited or frenzied mood, which can be dangerous and require hospitalization) and may also cause episodes of depression. For patients with bipolar I disorder, Lamictal does not actually treat the episodes of mania or depression—but as a mood stabilizer, it can help increase the time between episodes of mania, depression, and other abnormal moods. 

How Lamictal works for depression

Lamictal is available in various formulations, including immediate-release and extended-release tablets, chewable tablets, and orally disintegrating tablets. Lamictal is an anticonvulsant medication and helps to control seizures. Although it is an antiseizure medicine, it can also be used to treat people with bipolar I disorder who experience episodes of mania and depression. 

For people with bipolar I disorder who take Lamictal, it does not actually help depressive symptoms the way a typical antidepressant, like Prozac (fluoxetine), does. Rather, it is used to extend the time between episodes of depression and mania. The way that Lamictal works for this use is not understood. 

It’s important to note that Lamictal is not FDA-approved to treat major depressive disorder (depression or major depression). Also, Lamictal XR, an extended-release form of Lamictal, is FDA-approved to treat seizures, but it is not FDA-approved to treat bipolar disorder.

Lamictal dosage for depression

Before starting Lamictal, the medical professional will screen for drug interactions. Be sure to tell your healthcare provider about all the medications you take, including prescription and over-the-counter (OTC) drugs, vitamins, and supplements.

In terms of interacting drugs, certain drugs are known as enzyme inducers, such as Tegretol (carbamazepine), Dilantin (phenytoin), phenobarbital, and Mysoline (primidone). These and certain other drugs can affect Lamictal, so the Lamictal dosage may need to be adjusted based on what other medications the individual takes. 

When starting a patient on Lamictal, healthcare providers generally start with lower doses and gradually increase the dose. For people with bipolar disorder and episodes of depression who take medication for bipolar disorder but do not take an enzyme-inducing drug such as the ones listed above, the Lamictal dosage is as follows: 

• For adults: The recommended initial dose of Lamictal is 25 mg by mouth once daily for two weeks, then 50 mg by mouth once daily for two weeks, then 100 mg by mouth once daily for one week, then 200 mg by mouth once daily thereafter.
• Although the use of lamotrigine in bipolar depression is FDA-approved for adult patients, it is not approved for children and adolescents. Use in this age group would be considered off-label, which means the use is not approved by the FDA. This off-label dosage is as follows:
  • For ages 12–17 years: The starting dose is 25 mg by mouth once daily for two weeks, then 50 mg per day (in one or two divided doses) for two weeks, then 100 mg per day (in one or two divided doses). The dose may be gradually increased, if needed, up to a maximum of 500 mg per day in two divided doses (250 mg twice daily). 
  • For ages 6–11 years: The dosage is based on weight and will be gradually increased by the healthcare provider to a usual dose of 5 to 15 mg/kg/day up to a maximum of 400 mg per day in two divided doses (200 mg twice daily). 

For individuals who are being treated for bipolar disorder and also take Depakote (divalproex) or valproic acid, the dosage is as follows: 

• For adults: 25 mg by mouth every other day for two weeks, then 25 mg by mouth once daily for two weeks, then 50 mg by mouth once daily for one week, then 100 mg by mouth once daily. If Depakote or valproic acid is discontinued, the Lamictal dose will be increased to 150 mg per day for one week, then 200 mg per day.
• Off-label use in pediatric patients 12–17 years old: The starting dose is 12.5 mg by mouth once daily for two weeks. Then, the healthcare provider will gradually increase the dose to a usual dose of 50–100 mg per day in two divided doses. 

For individuals who are being treated for bipolar disorder and also take carbamazepine or certain other enzyme-inducing drugs, the dosage is as follows: 

• For adults: 50 mg by mouth once daily for two weeks, then 50 mg by mouth twice daily for two weeks, then 100 mg by mouth twice daily for one week, then 150 mg by mouth twice daily for one week, then up to a dose of 200 mg twice daily. If carbamazepine or another enzyme-inducing drug is stopped, the Lamictal dose should remain at 400 mg daily for one week. Then, the dose may be decreased every week as directed by the healthcare provider to a dose of 200 mg per day.

Note that these are general guidelines for dosages. Your dosage may vary based on individual factors. 

When does Lamictal start working for depression?

One study on the use of Lamictal in bipolar depression found that Lamictal may start to work within three weeks. However, because the dose is gradually increased to reduce the risk of adverse effects, it may take longer to get to an effective dose. In many cases, if the dosage is increased over a period of six weeks, it could take up to six weeks to see the full effect of this medication. 

Efficacy of Lamictal for depression

A review of clinical trials published in 2021 found Lamictal to be a first-choice drug for bipolar depression when considering both effectiveness and how well the drug is tolerated. However, in terms of the efficacy of lamotrigine alone, the researchers found it to be less effective than other medications. 

It’s hard to say which drug will be most effective for someone with bipolar depression. There are many factors to consider in choosing a medication, and it may take a bit of trial and error to find the best medication and dose for you. 

Guidelines note that each medicine for bipolar disorder has both pros and cons. The risk of suicide is lower when individuals are more satisfied with their care, so it is important to keep in close contact with your healthcare provider to find the right medication(s) and treatment plan (including other measures such as therapy) to treat your condition. 

Lamictal side effects

Common side effects of Lamictal for depression include: 

• Nausea
• Insomnia
• Extreme drowsiness
• Fatigue 
• Back pain
• Skin rash
• Runny nose
• Stomach pain
• Dry mouth

Lamictal has a boxed warning, also called a black box warning, which is the most serious warning required by the FDA. This warning states that Lamictal has been associated with several types of serious and life-threatening rashes (rare cases of toxic epidermal necrolysis and Stevens-Johnson syndrome), which have included death. The risk is higher in pediatric patients as well as:

• Individuals who take Lamictal with Depakote or valproate
• Individuals who take a higher starting dose of Lamictal than recommended
• Individuals who increase the Lamictal dose faster than recommended

Lamictal may also cause a rash that is relatively harmless. However, it is impossible to know which type of rash may turn out to be life-threatening. Therefore, if you take Lamictal and you have any signs of a rash, you should stop taking Lamictal and notify your healthcare provider.  Serious skin rashes always require emergency medical care. A serious skin rash may peel or blister, be red or purple in color, and be accompanied by symptoms such as fever, sore throat, and a burning feeling in the eyes.

In addition to the boxed warning, other serious side effects may occur. If you experience a serious side effect, you should consult your healthcare provider right away, or call 911 and get emergency medical help if symptoms seem life-threatening. This includes symptoms of an allergic reaction (hives, difficulty breathing or swallowing, or swelling of the face, lips, tongue, or throat). Other serious side effects include, but are not limited to:

• Headache, fever or chills, stiff neck, nausea and vomiting, confusion, muscle pain, drowsiness, sensitivity to light
• Unusual bleeding or bruising, such as nosebleeds or bleeding gums
• Feeling like the heart is racing or skipping a beat, shortness of breath, dizziness or lightheadedness, fainting
• Signs of infection, such as fever
• Problems with walking 
• Vision problems such as blurred or double vision

Precautions when taking Lamictal for depression

In addition to the side effects and boxed warning listed above, other warnings and precautions listed in the prescribing information for Lamictal include:

• Before taking Lamictal, tell your healthcare provider about all of your medical conditions, especially if you have had any mental health conditions, suicidal thoughts or behavior, or a history of heart problems. 
• Tell your provider if you are pregnant, planning to become pregnant, or breastfeeding. 
• Lamictal has many potential drug interactions, which can cause serious side effects. Tell your healthcare provider about all the medications you take, including prescription and OTC drugs, vitamins, and supplements. 
• Lamictal can cause various types of reactions or other problems that can affect organs and other body parts. Call your healthcare provider right away if you have symptoms such as fever, infections, muscle pain, swelling of the face, swollen lymph glands, pale skin, fatigue, weakness, or unusual bleeding or bruising. Other concerning symptoms that require medical attention include jaundice (yellowing of the skin and whites of the eyes), difficulty walking or seeing, seizures, or stomach pain and tenderness. 
• If you have heart problems, Lamictal can make your heart beat faster. Let your doctor know right away if you feel like your heart is skipping a beat, if your heartbeat feels faster, slower, or pounding, if you feel dizzy and lightheaded, or if you have difficulty breathing or chest pain. 
• In rare cases, Lamictal may cause you to have suicidal thoughts or actions. Call your healthcare provider right away, or you can call 911 for emergency help, or call 988 for the 988 Suicide & Crisis Lifeline if you have any of the following symptoms: thinking about or attempting to commit suicide, depression, anxiety, agitation, restlessness, panic attacks, irritability, trouble sleeping, aggression, impulsivity, or having an extreme increase in activity and talking.  
• Stopping Lamictal abruptly can lead to serious problems. Do not stop taking Lamictal suddenly. 
• Lamictal can cause a serious side effect called aseptic meningitis. This is a serious inflammation of the protective membrane of the brain and spinal cord. Get medical attention if you have a painful headache, fever or chills, nausea, vomiting, neck stiffness, muscle pain, confusion, drowsiness, or sensitivity to light. 
• Some medications look alike or sound alike, which could increase the risk of an error. Always check the Lamictal tablets when you refill your prescription, read the medication guide that comes with your prescription, and check with your pharmacist if the medication looks different.

Bottom line

Lamictal (lamotrigine) can be used to treat various types of seizures or as a mood stabilizer for the treatment of bipolar depression. While it does not treat symptoms of depression like a typical antidepressant medication would, Lamictal helps increase the time between episodes of mania, depression, and other abnormal moods. There are various considerations to take into account with Lamictal, such as potential side effects, drug interactions, and other concerns. Consult your healthcare professional for more information about Lamictal and whether it is right for you.