what is lamictal used for in depression

what is lamictal used for in depression

Lamotrigine

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

Like different temper stabilizers, lamotrigine was initially developed as an anticonvulsant to deal with seizures and is usually used with different drugs within the remedy of bipolar (manic-depressive) dysfunction. For the newest info on using lamotrigine, Psycom spoke with Joseph Goldberg, MD, Medical Professor of Psychiatry on the Icahn Faculty of Drugs at Mount Sinai in New York, and co-author of Managing the Aspect Results of Psychotropic Medicines, 2nd Ed, a textbook printed by American Psychiatric Affiliation Publishing and Christopher Aiken, MD, the director of the Temper Remedy Middle in North Carolina.

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Lamotrigine is the one temper stabilizer that calms temper swings by lifting the melancholy fairly than suppressing the mania, says Dr. Aiken. “That makes it an ideal selection for the bipolar spectrum, the place the depressive signs normally outweigh the manic ones. Its biggest profit is in prevention. It might probably stop each the depressive and manic aspect, however its advantages are a lot stronger for melancholy and it doesn’t deal with lively mania or hypomania.”

Dr. Aiken provides that a part of the rationale sufferers want lamotrigine is that it’s typically freed from unwanted side effects. “Within the unique analysis research individuals reported extra unwanted side effects on the placebo than on lamotrigine. Which will sound not possible, however it’s possible that lamotrigine helped them really feel higher bodily by treating their melancholy,” explains the temper dysfunction skilled including that lamotrigine can also be largely freed from the “medicated” emotions that folks dislike with temper stabilizers. “Individuals don’t are inclined to really feel uninteresting, flat, or groggy on it.”

In some analysis research evaluating a placebo to the medication, the outcomes have been distinctive. “Lamotrigine is the one medication we all know of the place sufferers have been unable to inform they have been taking the treatment,” he explains. “It didn’t make them really feel medicated, and its advantages constructed up very progressively. After 2 years, individuals taking lamotrigine had half as many days of melancholy as those that didn’t take it.”

Which circumstances are handled with lamotrigine?

Though lamotrigine shouldn’t be thought of an antidepressant, it’s used as a upkeep remedy for bipolar I dysfunction to assist stabilize temper adjustments. (Bipolar I dysfunction is characterised by manic episodes.) 1,2

“The drug producer’s unique research of lamotrigine in bipolar melancholy discovered that enhancements have been stronger in bipolar 1 than bipolar II dysfunction,” Dr. Goldberg recollects. (Bipolar II dysfunction is characterised by longer episodes and extra frequent prevalence of main melancholy and hypomania.) Newer analysis suggests, nevertheless, that lamotrigine could also be much more efficient as a temper stabilizer in stopping relapses in treating bipolar II dysfunction.2

There are additionally circumstances lamotrigine treats off-label together with borderline persona dysfunction, schizoaffective dysfunction, and obsessive-compulsive dysfunction (OCD), Dr. Aiken says.

How does lamotrigine work?

Lamotrigine delays the time between temper adjustments and manic or depressive states in individuals with bipolar dysfunction by lowering the depth of irregular electrical exercise within the mind. Individuals with bipolar dysfunction are at excessive danger of experiencing recurrent and relapsing episodes of temper change. Upkeep remedy with lamotrigine helps scale back the danger by stopping or delaying these recurrences and relapses.

“Many clinicians suppose that lamotrigine helps obtain and maintain even moods over time by advantage of its antidepressant properties, fairly than anti-manic (mood-stabilizing) properties,” says Dr. Goldberg. “It really works with temper stabilizers like lithium and Divalproex, however it’s not interchangeable with these medicine and can’t be used of their place.”

Lamotrigine is used over time as a preventative treatment. Medical trials that checked out lamotrigine’s potential for treating acute (in-the-moment) episodes of mania discovered no distinction between the treatment and placebo.2

Is there a typical dose of lamotrigine?

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Your physician will initially prescribe a low dose of lamotrigine and progressively enhance your dose each week or two for a number of weeks, till you attain an efficient dose degree.

“Remedy pointers for goal blood ranges of lamotrigine haven’t been established for circumstances apart from epilepsy,” Dr. Goldberg factors out. “In relapse prevention research carried out by its producer, nevertheless, 200 mg/day was discovered to be a greater goal dose than 50 mg/day, whereas greater doses (400 mg/day) didn’t present better profit in opposition to relapse.”

The dosing routine of lamotrigine can rely on which different drugs you take to deal with bipolar dysfunction, and is adjusted if you wean off and discontinue different drugs.

“Some medicines decelerate the metabolism of lamotrigine (notably, Divalproex), requiring a slower fee of enhance and a decrease goal dose,” notes Dr. Goldberg. “Others velocity up its metabolism (notably, carbamazepine), requiring a faster-than-usual dose enhance and a higher-than-usual goal dose.”

Lamotrigine is available in a number of kinds for treating bipolar dysfunction: Tablets, chewable tablets, dissolving tablets. Your physician could inform you to take tablets as soon as a day, twice a day or each different day.

When you miss a dose of lamotrigine, take the missed dose as quickly as you bear in mind. Whether it is near the time of your subsequent dose, nevertheless, skip the missed dose and proceed together with your normal schedule. By no means take a double dose of lamotrigine.

How lengthy does it take to work?

In sure circumstances, the antidepressant and antimanic advantages of lamotrigine are observed fairly early on within the remedy cycle, says Dr. Aiken. “For another sufferers, although, results are seen after a few month of being on lamotrigine remedy. However there’ll at all times be others that take a bit longer to expertise the constructive results.”

Price of Lamictal/Lamotrigine

When ordered in numerous 100 tablets, right here is the breakdown in pricing for one pill of the treatment within the following doses (Observe: pricing info generated April 2011):

  • $4.83 for 25 mg pill
  • $5.43 for 100 mg pill
  • $5.93 for 150 mg pill
  • $6.67 for 200 mg pill

Generic value (lamotrigine) is as follows:

  • $0.3 for 25 mg pill
  • $0.3 for 100 mg pill
  • $0.53 for 150 mg pill
  • $0.53 for 2000 mg pill

Benefits of Lamotrigine

Dr. Aiken stories there are some main benefits of lamotrigine together with:

  • It’s efficient in a majority of bipolar sufferers Nearly two-thirds of sufferers who’re affected by bipolar temper problems have responded extraordinarily effectively to lamotrigine.
  • It’s ideally suited for combined states Individuals who, on account of mania switches throughout intense biking, haven’t been capable of depend on different antidepressants have responded effectively to lamotrigine when given in therapeutic doses.
  • It’s good for sufferers who reply to nothing else Sufferers who fail to answer some other temper stabilizers and lithium have proven good outcomes when handled utilizing lamotrigine.
  • There are minimal unwanted side effects Lamotrigine has minimal unwanted side effects that normally fade away after a while.

Who can (and can’t) take lamotrigine for bipolar dysfunction?

Medical doctors could prescribe lamotrigine to adults or adolescents who’re in any other case being handled for bipolar dysfunction or weaning off different drugs used to deal with bipolar dysfunction. Older adults could also be extra delicate to the results of lamotrigine and prescribed decrease doses. “When individuals reply to lamotrigine, they usually say they will see issues in perspective higher and are much less reactive below stress. They normally nonetheless have days of melancholy, however these are typically shorter and fewer frequent,” says Dr. Aiken.

Kids below age 18 are at greater danger of growing a pores and skin rash from lamotrigine if dosed too quickly. Regardless of the potential unwanted side effects, nevertheless, Dr. Goldberg factors out that many research assist using lamotrigine for treating bipolar dysfunction in youth.

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Definitive details about the security of lamotrigine in being pregnant shouldn’t be accessible, however in response to Dr. Goldberg, many medical doctors understand it to be among the many safer choices when remedy is required, particularly in girls who’re extra vulnerable to melancholy than mania. Like many psychotropic medicine, lamotrigine is secreted into breast milk, so girls are suggested to debate with their medical doctors the danger and advantages of breastfeeding whereas taking lamotrigine.

Lamotrigine Aspect Results

Some individuals who take lamotrigine could expertise opposed reactions or unwanted side effects. In roughly 8 in 10,000 individuals, lamotrigine could cause extreme, life-threatening rashes and different pores and skin problems, usually between the second and eighth weeks of remedy. The chance of rash will increase with greater beginning doses, greater escalating doses and use of lamotrigine together with valproate. Early scientific trials and follow-up analysis confirmed that the general incidence of any pores and skin problems was 11 to 12% in each bipolar I and bipolar II sufferers handled with lamotrigine. 2

“Most of those pores and skin points are benign,” Dr. Goldberg emphasizes. “Critical rashes from lamotrigine will not be on account of an allergy, however fairly, a systemic response that additionally normally consists of fever, sore throat, swollen glands, and different bodily signs.”

However as with all treatment, Dr. Goldberg provides, allergic reactions to lamotrigine can happen. Get rapid emergency assist should you present any indicators of an allergic response, comparable to hives, facial or throat swelling, or issue respiratory. Notify your physician should you develop a pores and skin rash, particularly if it happens inside your mouth or on tender physique tissue comparable to eyelids or round nasal openings, and whether it is blistering, peeling, painful, burning, or entails a fever or sore throat. You should definitely report all drugs you take to medical employees.

Critical unwanted side effects that must be reported instantly to your physician embrace:

  • Any pores and skin rash, blistering or peeling of pores and skin
  • Painful (burning) sores in or across the mouth, eyes or genitals
  • Jaundice (yellowish pores and skin or eyes)
  • Swollen gland, fever, extreme muscle ache
  • Weak point, drowsiness, confusion
  • Stiff neck, headache
  • Elevated sensitivity to gentle
  • Temper or conduct adjustments, comparable to melancholy, anxiousness, agitation, hostility, restlessness, psychological or bodily hyperactivity, suicidal ideas

Widespread unwanted side effects of lamotrigine that aren’t emergencies however must also be reported to your physician embrace:

  • Headache or dizziness
  • Blurred or double imaginative and prescient
  • Dry mouth
  • Gastrointestinal misery comparable to nausea, vomiting, diarrhea or abdomen ache
  • Fever, sore throat, runny nostril
  • Drowsiness or fatigue
  • Tremor
  • Insomnia

Lamotrigine Rash

The largest danger with lamotrigine is a uncommon allergic response referred to as Stevens-Johnson Syndrome, which will be deadly if left untreated. Many drugs could cause this response, together with antibiotics like Bactrim and penicillin and over-the-counter drugs like Tylenol and Motrin. The chance of getting the rash will be prevented if the next precautions are adopted:

  1. Dosing will increase have to be raised very slowly.
  2. It must be stopped if any new rash or pores and skin adjustments happen when you’re beginning the treatment. (After the primary 3 months the danger of Stevens-Johnson Syndrome declines to nearly zero).
  3. To keep away from false-alarm rash confusion, using new soaps, getting a sunburn, publicity to poison ivy and beginning some other new drugs must be averted throughout the first 3 months of beginning lamotrigine.

With these steps, the danger of this extreme rash is about 1 in 3,000; with out them, it’s extra like 1 in 100. “Sadly, there’s nonetheless a excessive danger of non-serious, benign rashes (10% probability), so many individuals should cease lamotrigine to be on the secure aspect,” Dr. Aiken explains. “When you responded to lamotrigine however needed to cease it due to a rash, it might be potential to restart at a decrease dose.”

Does lamotrigine work together with any drugs or different substances?

Sure different medicine can have an effect on the way in which lamotrigine works in your physique by lowering its effectiveness or delaying its excretion out of your physique. These embrace hormonal contraception strategies, hormone remedies, seizure drugs comparable to phenobarbital, and valproic acid, which can also be used to deal with bipolar dysfunction.

Your physician will rigorously prescribe and monitor your dosage when lamotrigine is taken with different remedies. Keep away from alcohol, hashish, and different substances that may enhance dizziness or drowsiness whereas taking lamotrigine. To rule out harmful unwanted side effects, talk about all different drugs or mind-altering substances you eat together with your physician earlier than taking lamotrigine.

One latest British examine discovered that folic acid dietary supplements can cancel out lamotrigine’s advantages (Geddes et al., 2016). “Nobody anticipated that end result, as folic acid normally helps melancholy, and different drugs, like valproate (a temper stabilizer permitted for mania related to bipolar dysfunction, seizures/epilepsy, and migraine complications),” says Dr. Aiken. “Extra analysis is required earlier than we will absolutely belief this end result, however till then, we suggest taking lamotrigine with none folic acid dietary supplements, together with these present in multivitamins. When you’re doing effectively on lamotrigine, should you determined so as to add folic acid, be careful for a possible lack of advantages.”

Is it OK to abruptly cease taking lamotrigine?

Seek the advice of your physician earlier than stopping lamotrigine. When you do cease for quite a lot of days, DO NOT restart at your present dose. Name your physician to assessment your dosing schedule.

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