Can concomitant use of Abilify (aripiprazole) and Lamictal (lamotrigine) increase anxiety and suicidal ideation (SI)?

Concomitant Use of Abilify and Lamictal Can Increase Anxiety and Suicidal Ideation

Yes, concomitant use of Abilify (aripiprazole) and Lamictal (lamotrigine) can increase anxiety and suicidal ideation in some patients with mood disorders. This combination requires careful monitoring and potential discontinuation if these symptoms emerge.

Evidence for Increased Risk

The most recent and direct evidence comes from case reports documenting severe adverse effects when these medications are used together:

• A 2015 study reported cases of patients with mood disorders who developed severe akathisia, anxiety, and suicidal ideation while using a combination of aripiprazole, lamotrigine, and antidepressants 1

• Aripiprazole alone has been associated with anxiety, akathisia, and suicidal thoughts, even at low doses. One case report documented acute akathisia with suicidal ideation in a 23-year-old patient with mood disorder taking low-dose aripiprazole 2

Mechanism of Action and Risk Factors

The FDA label for aripiprazole specifically warns about the potential for:

• Emergence of anxiety
• Agitation
• Akathisia (psychomotor restlessness)
• Suicidal ideation, especially early during treatment or when doses are adjusted 3

This risk appears to be heightened when:

• Multiple psychotropic medications are combined
• Dose adjustments are made
• Treatment is initiated

Monitoring and Management Recommendations

If this combination is necessary for treatment:

1. Start aripiprazole at low doses when combined with lamotrigine
2. Monitor closely for:
   • Emergence of anxiety
   • Akathisia (inner restlessness, inability to sit still)
   • New or worsening suicidal thoughts
   • Agitation or hostility
   • Impulsivity
3. Schedule frequent follow-ups during the initial treatment period and after any dose changes
4. Educate patients and caregivers to report concerning symptoms immediately
5. Discontinue aripiprazole if limiting side effects like akathisia, increased anxiety, or suicidal thoughts develop 1

Special Considerations

Patients at higher risk for these adverse effects may include:

• Those with pre-existing anxiety disorders
• Patients with a history of suicidal ideation
• Individuals taking multiple psychotropic medications
• Those with treatment-resistant depression

Alternative Approaches

If a patient experiences these adverse effects:

1. Consider discontinuing aripiprazole
2. Evaluate for alternative mood stabilizers or antipsychotics with lower risk profiles
3. Consider non-pharmacological approaches for mood stabilization when appropriate

Conclusion

Healthcare providers should maintain vigilance when prescribing this combination, especially during the initial treatment phase and dose adjustments. The emergence of anxiety, akathisia, or suicidal ideation should prompt immediate reevaluation of the treatment regimen.