Lamotrigine is one of the important medications for the treatment of bipolar disorder. However, there are some important details that we need to know about its use.
Does lamotrigine not work for anything acutely?
Is there important unpublished data about lamotrigine that might alter what we think about its efficacy?
Are we increasing the risk of Stevens-Johnson Syndrome by following the FDA-approved titration schedule for lamotrigine?
What clinical conditions increase risk of Stevens-Johnson Syndrome and suggest that lamotrigine should be avoided if possible?
What important detail must be included when documenting that we told the patient about the risk of Stevens-Johnson syndrome?
What should we do if the patient develops a rash?
These questions are addressed by S. Nassir Ghaemi, MD, MPH, Professor of Psychiatry and Director of the Mood Disorders Program at Tufts University School of Medicine in the interview below. Dr. Ghaemi is also Editor of The Psychiatry Letter, a monthly newsletter described as “The monthly source for independent-minded, scientifically-sound practice.”
What do you think? Do you agree? Did you find these tips helpful? Any other suggestions? Either way, make sure to leave your comments at the bottom of this page under “Leave a Reply.”
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Any recommendations at all regarding lamictal use in PTSD
Very valuable information about lamictal.when we attend lecture arrange by GSK for promotion of their product,speaker from their behalf always stress about there immediate role in Bipolar disorder having depression predominant,but your valuable talk enlighten me for future effects of Lamotigine(lamictal),then why they misguide others.
Thanks Dr. Mago for this valuable clinical tips from this interview with Dr. Ghaemi. I agree in my practice with his cautious slow up titration, even slower than epilepsy textbooks. But, I did not get his point about when we start lamotrigine early, we will not count on. So, will we start it in the acute phases just to get the benefits after in the remission phase? If so, how to avoid problems of drug interactions, as we will be dependent on other mood stabilizers eg valproate. Best regards
Thanks, Dr. Ghoury, for your comment and question! I think that lamotrigine for prophylaxis can be started at any time including when the person is in an acute depressive episode. Dr. Ghaemi’s point was that because it does not work in the acute phase, it is not urgent to titrate up as quickly as possible. You are right in saying that he is recommending a rate of titration for those not on valproate, carbamazepine, etc. The final dose and sometimes the rate of titration may have to be adjusted if the person is on a medication that increases or decreases lamotrigine levels.
Excellent Dr. Mago
Thanks, Dr. Ghoury, for your encouragement!
Thanks Raj. A good reminder on Lamictal. Although I am well aware of the SJS side effect, everytime I have informed my patient of this rash, i have always wondered distinguishing between severe and not to serious of a rash and what to do once I have discovered a “not so serious of a rash”. In fact, I have yet to see any rash on patients during young psychiatric career on Lamictal. But I guess from this video, the take home point is, at baseline before starting on Lamictal if patient has any rash at all and if at any point after starting Lamictal there are any complains of rash, we can simply stop the medication.
Thanks, Amer!