Lamictal (Lamotrigine) and Suicidal Thoughts
Lamictal (lamotrigine) carries a risk of causing suicidal thoughts, particularly in patients under 24 years of age, though the absolute risk is relatively low. According to the American Academy of Child and Adolescent Psychiatry, vigilant monitoring is recommended for young adults under 24 years of age when treated with antiepileptic medications like lamotrigine due to this risk 1.
Risk Assessment and Monitoring
- The risk of suicidal thoughts with lamotrigine appears to be part of a class effect seen with antiepileptic drugs
- Young adults under 24 years require particularly close monitoring during initiation and dose adjustments
- Risk may be heightened when lamotrigine is combined with other medications, particularly aripiprazole and antidepressants 2
Evidence on Lamotrigine and Suicidality
Research shows mixed findings regarding lamotrigine's effects on suicidal behavior:
- In a 6-month prospective study of 969 bipolar patients, lamotrigine treatment was associated with a significant decrease in suicide risk (from 17% at baseline to 2.1% at study completion) with no suicide attempts occurring during the study period 3
- However, case reports document instances where lamotrigine has been associated with increased anxiety, akathisia, and suicidal thoughts, particularly when used in combination with other medications 2
- There are also documented cases of lamotrigine overdose in suicide attempts, highlighting the importance of risk assessment 4
Clinical Considerations
When prescribing lamotrigine:
- Start with low doses and titrate slowly to minimize side effects
- Monitor closely for emergence of psychiatric symptoms including mood changes, anxiety, agitation, or suicidal thoughts
- Be particularly vigilant when:
- Initiating treatment
- Adjusting dosages
- Adding or removing other medications from the regimen
- Treating patients with a history of suicidal behavior
Medication Interactions
- The combination of lamotrigine with aripiprazole and antidepressants appears to increase the risk of akathisia, anxiety, and suicidal thoughts 2
- These combinations should be used cautiously with careful monitoring for emergent symptoms
Balancing Benefits and Risks
Lamotrigine has established efficacy in:
- Epilepsy treatment
- Bipolar disorder maintenance, particularly for preventing depressive episodes 5
- The antisuicidal benefits in stabilized patients may outweigh the initial risks 6, 3
Warning Signs to Monitor
Monitor patients for:
- New or worsening anxiety
- Agitation or restlessness (akathisia)
- Emergence of suicidal thoughts or behaviors
- Sleep disturbances
- Mood changes or instability
- Psychotic symptoms (rare but reported) 5
If these symptoms emerge, prompt clinical evaluation and potential medication adjustment is necessary.