From the Guidelines
Lamotrigine may be considered as a treatment option for self-injurious behavior (SIB), particularly in patients with underlying mood disorders, borderline personality disorder, or epilepsy, as part of a comprehensive treatment approach that includes psychotherapy, such as dialectical behavior therapy or cognitive behavioral therapy, as supported by recent guidelines 1.
Key Considerations
- The typical starting dose of lamotrigine is 25mg daily, gradually titrated upward by 25mg every 1-2 weeks to minimize the risk of serious rash, with a target dose range of 100-200mg daily (sometimes up to 400mg daily in divided doses) 1.
- Treatment duration should be at least 8-12 weeks to properly assess efficacy, and if beneficial, it may be continued long-term with regular monitoring.
- Blood tests for baseline liver and kidney function should be performed before starting treatment, and patients should be monitored for adverse effects including rash (which can rarely progress to Stevens-Johnson syndrome), dizziness, headache, and blurred vision.
- Recent studies have shown that dialectical behavior therapy (DBT) and cognitive behavioral therapy (CBT) are effective in reducing suicidal ideation and behavior in patients with borderline personality disorder and other conditions 1.
Psychotherapy
- DBT and CBT should be used as part of a comprehensive treatment approach for patients with self-injurious behavior, as they have been shown to be effective in reducing suicidal ideation and behavior.
- These therapies can help patients develop skills in emotion regulation, interpersonal effectiveness, and distress tolerance, which can help reduce impulsivity and emotional dysregulation that often underlie self-injurious behaviors.
Medication Management
- Lamotrigine should be tapered slowly when discontinuing to avoid withdrawal symptoms or rebound in self-injurious behaviors.
- Patients should be monitored regularly for adverse effects and efficacy of the medication, and the treatment plan should be adjusted as needed.
From the Research
Lamotrigine Use in Self-Injurious Behaviour
- The use of lamotrigine in self-injurious behaviour has been explored in a limited number of studies, with one notable case report published in 1996 2.
- This case report described an 18-year-old female with profound mental retardation, generalized seizure disorder, stereotypic movement disorder, and compulsive self-injurious behaviour, who showed a 50% reduction in the frequency of self-injurious behaviour after 4 weeks of treatment with lamotrigine 200 mg daily.
- The study suggested that lamotrigine may decrease glutamate release, which may have a role in the pathophysiology of self-injurious behaviour, as supported by animal models of self-injurious behaviour 2.
- However, it is essential to note that this is a single case report, and no clinical recommendations for the treatment of self-injurious behaviour with lamotrigine can be made until controlled studies have been completed 2.
Limitations and Lack of Research
- There is a lack of research on the use of lamotrigine in self-injurious behaviour, with most studies focusing on its use in bipolar disorder and epilepsy.
- The available studies on lamotrigine in bipolar disorder do not provide direct evidence for its use in self-injurious behaviour, although they do suggest that lamotrigine may have mood-stabilizing and antidepressant properties in some patients with bipolar disorder 3, 4, 5.
- Therefore, more research is needed to fully understand the potential benefits and risks of using lamotrigine in self-injurious behaviour.
Safety and Efficacy Considerations
- Lamotrigine has been associated with serious side effects, including Stevens-Johnson syndrome, toxic epidermal necrosis, and drug-related eosinophilia and systemic symptoms 6.
- Prescribers should be aware of these potential risks and take steps to minimize them, including slow dose escalation and monitoring for signs of adverse reactions 6.