From the Guidelines
Lamotrigine is not recommended as a first-line or standard treatment for ADHD. The most recent and highest quality study 1 provides an overview of available medications for the treatment of ADHD, and lamotrigine is not listed as a recommended treatment option. The established first-line pharmacological treatments for ADHD include stimulants such as methylphenidate and amphetamine-based medications, followed by non-stimulants like atomoxetine, guanfacine, and clonidine. These medications have substantial research supporting their efficacy and safety profiles for ADHD management, as discussed in 1 and 1.
The key considerations in treating ADHD include the severity of symptoms, presence of comorbidities, and patient preferences. The neurobiological basis for ADHD primarily involves dopamine and norepinephrine neurotransmitter systems, while lamotrigine works through different mechanisms involving glutamate and sodium channels, which explains why it's not particularly effective for the attention, hyperactivity, and impulsivity symptoms characteristic of ADHD.
Some potential benefits of non-stimulants, such as atomoxetine, clonidine, and guanfacine, include their non-controlled status and "around-the-clock" effects, as well as their potential to be used as first-line treatment options in certain comorbidities, such as disruptive behavior disorders, tic disorder, and substance use disorders, as discussed in 1. However, lamotrigine is not considered a viable option for these cases, and its use in ADHD treatment is not supported by the current evidence.
In summary, the current evidence does not support the use of lamotrigine as a standard treatment for ADHD, and stimulants and non-stimulants remain the preferred treatment options, with the choice of medication depending on individual patient factors and comorbidities, as discussed in 1, 1, and 1.
From the Research
Lamotrigine for ADHD
- Lamotrigine is an anticonvulsant that has been reported to be effective in adult ADHD comorbid with bipolar II disorder 2.
- A retrospective chart review of 40 patients with adult ADHD and comorbid mood disorders found that 77.5% of patients improved with lamotrigine, with a mean dose of 125.6 mg 2.
- The study suggests that lamotrigine may be a safe and effective treatment option for adult ADHD comorbid with bipolar and recurrent depression 2.
Efficacy and Safety of Lamotrigine
- A systematic review of 13 studies found that lamotrigine is effective in preventing recurrence and relapse, particularly depressive relapse, in stabilized patients with bipolar disorder 3.
- The review also found that lamotrigine has a relatively favorable safety and tolerability profile, provided that there is slow dose escalation to reduce the probability of skin rash 3.
- Another systematic review of 11 studies found that lamotrigine may be superior to placebo in the maintenance treatment of bipolar disorder, with a possible advantage in preventing recurrence of manic symptoms 4.
Comparison with Other Treatments
- A study comparing lamotrigine with lithium found that efficacy was similar between groups, except for recurrence of mania episode at one year, which was higher in the lamotrigine group 4.
- The study also found that participants treated with lamotrigine experienced fewer adverse effects compared to those treated with lithium 4.
- A review of the use of stimulants and atomoxetine in adults with comorbid ADHD and bipolar disorder found that atomoxetine may be effective in treating ADHD symptoms, but with a modestly increased risk of (hypo)manic switches and destabilization of the mood disorder 5.