From the Guidelines
Lamictal (lamotrigine) is an effective medication for treating hypomania in bipolar disorder, particularly for preventing future hypomanic episodes rather than treating acute symptoms. The typical treatment begins with a low dose of 25mg daily for two weeks, then gradually increases by 25-50mg every 1-2 weeks until reaching a therapeutic dose of 100-200mg daily (sometimes up to 400mg if needed) 1. This slow titration is crucial to reduce the risk of serious skin rashes, including Stevens-Johnson syndrome. Lamictal works by stabilizing mood through modulation of sodium channels and glutamate release in the brain, making it particularly effective for the depressive phase of bipolar disorder while also preventing hypomanic episodes.
Some key points to consider when using Lamictal for hypomania include:
- It's generally well-tolerated with fewer side effects than other mood stabilizers like weight gain or cognitive dulling 1.
- Common side effects include headache, dizziness, double vision, and skin rash.
- Any rash while taking Lamictal should prompt immediate medical attention.
- Lamictal is often used as part of a comprehensive treatment plan that may include other medications for acute hypomania, such as antipsychotics or lithium, as Lamictal alone may not be sufficient to quickly resolve an active hypomanic episode 1.
- The treatment recommendations for early-onset bipolar disorder are derived from the adult literature for acute mania, and traditional mood stabilizers (e.g., lithium, valproate) and/or atypical antipsychotic medications are the primary treatment.
It's essential to note that the evidence for using Lamictal in hypomania is based on its efficacy in preventing future episodes rather than treating acute symptoms, and it should be used under the guidance of a healthcare professional.
From the Research
Efficacy of Lamictal for Hypomania
- Lamotrigine (Lamictal) has shown efficacy in delaying manic/hypomanic episodes in pooled data, although lithium was superior to lamotrigine on this measure 2, 3.
- The mechanism of action of lamotrigine in patients with bipolar disorder may be related to the inhibition of sodium and calcium channels in presynaptic neurons and subsequent stabilisation of the neuronal membrane 2, 3.
- Lamotrigine monotherapy significantly delayed time to intervention with additional pharmacotherapy or electroconvulsive therapy for any new mood episode (mania, hypomania, depression and mixed episodes), compared with placebo, in two large, randomised, double-blind trials of 18 months' duration 2, 3.
Safety and Tolerability
- Lamotrigine was generally well tolerated in maintenance studies with the most common adverse events being headache, nausea, infection and insomnia 2, 3.
- The incidence of serious rash with lamotrigine treatment was 0.1% in all studies of bipolar disorder and included one case of mild Stevens-Johnson syndrome 2, 3.
- Lamotrigine did not appear to cause bodyweight gain, and unlike lithium, generally does not require monitoring of serum levels 2, 3.
Comparison with Other Treatments
- 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, and showed limited efficacy in delaying time to intervention for a manic/hypomanic episode, compared with placebo 2, 3.
- In comparison to lithium, people with bipolar disorder seem to tolerate lamotrigine better in the long run, however, the demonstrated efficacy in the maintenance of bipolar disorder was similar between the two groups 4.
- First-line therapy for bipolar disorder includes mood stabilizers, such as lithium, anticonvulsants, such as valproate and lamotrigine, and atypical antipsychotic drugs 5.