From the Research
Lamotrigine is a good treatment for Bipolar II disorder, particularly for preventing depressive episodes, as it has been shown to be effective in maintaining mood stability with fewer side effects compared to other mood stabilizers 1. The most recent and highest quality study, a 2021 systematic review, found that lamotrigine had a possible advantage over placebo in preventing recurrence of manic symptoms and clinical worsening, with a low to moderate certainty of evidence 1. Some key points to consider when using lamotrigine for Bipolar II disorder include:
- Starting with a low dose of 25mg daily for two weeks, then gradually increasing by 25mg every two weeks until reaching a therapeutic dose of 100-200mg daily (sometimes up to 400mg if needed) to reduce the risk of serious rashes, including Stevens-Johnson syndrome.
- Lamotrigine is especially valuable for patients whose bipolar symptoms are dominated by depression rather than mania or hypomania.
- It works by modulating glutamate and calcium channels in the brain, which helps stabilize mood without the sedation, weight gain, or cognitive dulling associated with some other mood stabilizers.
- Blood monitoring isn't typically required, unlike with lithium or valproate.
- Patients should be aware of potential side effects including headache, dizziness, double vision, and most importantly, skin rashes, which should prompt immediate medical attention.
- Lamotrigine may be less effective for preventing hypomanic episodes, so some patients might need additional medications if hypomania is a significant concern. Overall, lamotrigine is a valuable treatment option for Bipolar II disorder, particularly for patients with depressive symptoms, due to its efficacy and relatively favorable side effect profile 1.