Can lamotrigine (anticonvulsant medication) cause self-harm urges?

Lamotrigine and Self-Harm Urges

Lamotrigine can potentially cause self-harm urges in rare cases, as it has been documented to induce anger with murderous impulses and other psychiatric symptoms in some patients. 1

Psychiatric Side Effects of Lamotrigine

Lamotrigine is an anticonvulsant and mood stabilizer commonly used for:

• Epilepsy with partial and generalized seizures
• Maintenance therapy in bipolar disorder
• Prevention of depressive episodes in bipolar disorder 2

While generally well-tolerated, lamotrigine has been associated with several psychiatric adverse effects:

• Serious psychiatric symptoms:

  • Anger with murderous impulse 1
  • Full acute psychotic episodes 2
  • Hallucinations 2
  • Affective switches 2

• Case reports highlight:

  • A 22-year-old man who developed anger and murderous impulse at 125 mg/day of lamotrigine (symptoms improved when dose was reduced to 75 mg/day) 1
  • A 23-year-old woman who experienced similar symptoms at just 25 mg/day (symptoms resolved immediately upon discontinuation) 1

Risk Factors and Monitoring

Patients taking lamotrigine should be monitored for:

• Emergence of new psychiatric symptoms, particularly:

  • Unusual anger or aggression
  • Violent thoughts or impulses
  • Suicidal ideation
  • Mood changes
  • Psychotic symptoms

• Higher risk populations:

  • Patients with pre-existing mood disorders
  • Patients with history of self-harm or suicidal ideation
  • Those with intellectual disabilities (who have shown increased risk of aggressive behavior on lamotrigine) 1

Clinical Management

If self-harm urges or severe anger emerge during lamotrigine treatment:

1. Consider dose reduction - Lower doses may alleviate symptoms while maintaining therapeutic benefit 1

2. Consider discontinuation if symptoms are severe or persist despite dose reduction

3. Gradual tapering is recommended if discontinuation is necessary to avoid withdrawal effects 3

4. Alternative medication options should be considered based on the original indication for lamotrigine

Important Caveats

• The overall incidence of serious psychiatric adverse effects with lamotrigine appears to be low 4

• Most clinical trials report lamotrigine as generally well-tolerated with an adverse event profile comparable to placebo 4

• The benefits of lamotrigine in treating bipolar disorder and epilepsy must be weighed against these potential risks

• Patients and caregivers should be educated about potential psychiatric symptoms and instructed to report them immediately

• Regular follow-up is essential, especially during dose adjustments or early in treatment

While lamotrigine is an effective medication for epilepsy and mood disorders, clinicians must remain vigilant about the potential for psychiatric side effects, including self-harm urges, which can occur even at therapeutic or low doses.