PsychRounds: The Psychiatry Podcast Mood Stabilizers: Lamotrigine (Lamictal)
5 snips
Jul 17, 2024 Discover the fascinating journey of lamotrigine, originally an anti-epileptic medication, and its surprising mood-stabilizing effects. Learn how it became a key player in treating bipolar disorder, especially for maintenance therapy. Hear about the importance of a slow titration schedule and the potential risks of serious rashes. Explore its favorable side-effect profile compared to lithium and the unique challenges in patients with genetic risk factors. Plus, insights on its off-label uses for conditions like unipolar depression and borderline personality disorder.
AI Snips
Chapters
Transcript
Episode notes
From Seizures To Bipolar Maintenance
- Lamotrigine (Lamictal) was discovered to improve mood when used as an anti-epileptic and later studied for bipolar disorder.
- It received FDA approval only for bipolar maintenance after large trials showed delayed time to next mood episode.
Maintenance Works; Acute Mania Doesn't
- Lamotrigine reliably delays relapse in bipolar maintenance but does not treat acute mania.
- Bipolar depression trials likely failed initially due to trials being too short for lamotrigine's slow onset.
Follow The Slow Titration Schedule
- Follow the strict titration: 25 mg weeks 1–2, 50 mg weeks 3–4, 100 mg week 5, 200 mg week 6.
- Target 100–200 mg/day for efficacy and only go up to 400 mg/day if clinically justified.