From the Guidelines
Lamotrigine is indeed considered a mood stabilizer, as evidenced by its FDA approval for maintenance therapy in adults with bipolar disorder. According to the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1, lamotrigine has been approved for maintenance therapy in adults, and open-label trials have described its effectiveness for adolescents with bipolar depression. The medication typically starts at a low dose (25mg daily) and is gradually increased over several weeks to a therapeutic dose (usually 100-200mg daily, sometimes up to 400mg daily) to reduce the risk of serious skin rashes, including Stevens-Johnson syndrome.
Some key points to consider when using lamotrigine as a mood stabilizer include:
- Its mechanism of action involves inhibiting voltage-sensitive sodium channels and reducing the release of excitatory neurotransmitters like glutamate in the brain, which helps stabilize mood 1.
- It is particularly effective for the depressive phase of bipolar disorder and may be less effective for acute mania compared to other mood stabilizers like lithium or valproate.
- Common side effects include headache, dizziness, double vision, and rash, and regular monitoring is important to evaluate any rash that develops while taking lamotrigine.
- The slow titration of lamotrigine is essential for safety, and healthcare providers should be cautious when prescribing this medication, especially in pediatric populations.
Overall, lamotrigine is a valuable option for the treatment of bipolar disorder, particularly for preventing depressive episodes and for maintenance treatment, and its use should be considered in the context of individual patient needs and medical history 1.
From the Research
Definition and Classification of Lamotrigine
- Lamotrigine is classified as an anticonvulsant agent that has shown efficacy in the prevention of mood episodes in adult patients with bipolar I disorder 2, 3.
- It is also considered a mood stabilizer, with its mechanism of action related to the inhibition of sodium and calcium channels in presynaptic neurons and subsequent stabilization of the neuronal membrane 4.
Efficacy in Bipolar Disorder
- Lamotrigine has been shown to be an effective maintenance therapy for patients with bipolar I disorder, significantly delaying time to intervention for any mood episode 2, 3.
- It has also been found to be effective in preventing depressive episodes, with some evidence suggesting efficacy in acute bipolar depression 4, 5.
- However, there is little or no strong evidence to support its efficacy in acute mania, unipolar depression, or rapid-cycling bipolar disorder 5.
Safety and Tolerability
- Lamotrigine is generally well tolerated, with the most common adverse events being headache, nausea, infection, and insomnia 2, 3.
- It does not appear to cause bodyweight gain and does not require monitoring of serum levels, unlike lithium 2, 3.
- However, it can cause rare but serious adverse effects, such as Stevens-Johnson syndrome, hemophagocytic lymphohistiocytosis, and drug reaction with eosinophilia and systemic symptoms syndrome 4.
Clinical Use
- Lamotrigine is approved by the Food and Drug Administration for the maintenance treatment of adults with bipolar disorder 4.
- It is also used off-label in the treatment of acute bipolar depression and has shown promising effects in bipolar disorder type II with rapid phase change 4.
- The dosage of lamotrigine is typically titrated over a 6-week period to 200 mg/day to minimize the incidence of serious rash 2, 3.