What is lamotrigine treatment for bipolar disorder?

Lamotrigine is an anticonvulsant used primarily in the treatment of epilepsy. Anticonvulsant medications influence the actions of neurotransmitters leading to a decrease in brain cell (neuron) excitability. In bipolar disorder, lamotrigine is used mainly for the treatment of depression.

What is the evidence for lamotrigine as a treatment for bipolar disorder?

Compared to placebo, high quality evidence finds a small effect of fewer relapses with lamotrigine to any mood state in stable patients. Moderate to high quality evidence suggests a small effect of greater improvement in depression symptoms, but not mania symptoms, with mono or adjunctive lamotrigine, and no differences in adverse events, including switching to mania.

Compared to other medications, moderate to high quality evidence suggests lamotrigine was less effective than tamoxefin, risperidone, haloperidol, or olanzapine for acute mania symptoms. Moderate to low quality evidence suggests fewer relapses with quetiapine than with lamotrigine, but lamotrigine was better tolerated than carbamazepine or lithium + valproate. There was more discontinuation with lamotrigine than with olanzapine, and more switching to mania with lamotrigine than with quetiapine or ziprasidone.

Moderate quality evidence suggests the rate of adverse dermatological reaction with lamotrigine is around 8.6%, with rates of Stevens-Johnson syndrome/toxic epidermal necrolysis, in particular, being around 0.02%.

There were no differences in symptoms or adverse events when lamotrigine was compared to lithium, olanzapine + fluoxetine, trancylpromine, citalopram, or inositol.

Also see the topic on relapse prevention.

November 2021

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Last updated at: 1:28 pm, 15th February 2022
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