Considering Lamictal for Depression? Read This

For many people with depression, finding the best kind of medication takes some trial and error. While the first line of treatment is typically antidepressants, these medications don’t always provide enough symptom relief, and a provider may recommend adding another medication. 

One medication that can be used in cases like this is Lamictal, which is a mood stabilizer primarily used in bipolar disorder treatment. Read on to learn more about what Lamictal is used for, if you should take Lamictal for depression, and more. 

What to know about taking Lamictal for depression

Lamictal is the brand name for lamotrigine, an anticonvulsant drug. The medication’s original intended use was as a seizure medicine for people with epilepsy, but it was later found to be useful for mental health. “In psychiatry, we use Lamictal primarily for mood stabilization,” says Rebecca Holland, a psychiatric nurse practitioner with Charlie Health. 

For this reason, Lamictal is used to help reduce mood swings and level out highs and lows in people with bipolar disorder (also known as bipolar depression) –– specifically those with bipolar I. Although Lamictal is only FDA-approved for bipolar disorder I treatment in the realm of psychiatry, some providers may still prescribe this mood stabilizer to people with bipolar II disorder since there is some promising research backing up its efficacy for those with this diagnosis. It’s available as an oral tablet, extended-release tablet (Lamictal XR), orally disintegrating tablet (Lamictal ODT), and chewable dispersible tablet.

Outside of bipolar disorder treatment, mood stabilizers like Lamictal can be used to help treat major depressive disorder alongside other medications. Lamictal can be a successful add-on or adjunct to some other medications, like selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) if an antidepressant isn’t bringing someone full relief, Holland says. 

For example, if you’re taking an antidepressant and feel like some of your symptoms have improved, but you still experience depressive episodes with low mood, adding Lamictal can help address these mood symptoms that are holding you down. 

This add-on approach allows for an individually tailored treatment plan, targeting aspects of depression that your traditional antidepressant isn’t quite reaching. When you use Lamictal to augment the effects of antidepressants, you may experience greater mood stabilization, reduced depressive symptoms, and overall improved well-being. 

Holland says Lamictal may be especially helpful in cases where someone with depression experiences distinct mood episodes of highs and lows but they don’t have a bipolar disorder diagnosis. In these instances, Lamictal can help stabilize mood and improve symptoms from both ends. 

Frequently asked questions about Lamictal for depression

Below, providers answer three commonly asked questions about taking Lamictal for depression.

1. Can Lamictal be used as a monotherapy for depression?

Claire Streeter, a psychiatric nurse practitioner with Charlie Health, says lamictal is not typically used as monotherapy — a treatment strategy involving the use of a single medication. “At this time, we do not have adequate evidence that proves that Lamictal on its own can treat depression,” she says. In the vast majority of cases, the only time Lamictal will be used as a monotherapy is for bipolar depression, especially in instances of bipolar I disorder.

2. How long does lamotrigine take to start working for depression?

It can take several weeks to months to feel the full effects of Lamictal, says Streeter. Part of this is because Lamictal is titrated very slowly. You start at a low dose and increase slowly. For example, you might start on 25 mg for the first two weeks and 50 mg for the next two weeks. If you’re tolerating it well and not experiencing any rash (more on that later) then you can continue to increase the dose. 

In some cases, your prescriber may recommend taking divided doses of Lamictal, meaning taking it twice a day instead of once a day. If your doctor prescribes you Lamictal, they’ll confirm if you should take divided doses or one daily dose. You will feel the maximum benefit of Lamictal once you have been at a high enough dose for a few weeks. 

3. How long is Lamictal typically prescribed for depression?

The duration of how long you take any psychiatric medication is highly personal. It will depend on how your symptoms have improved from the medication, any progress you’ve made in therapy, and much more.  It’s safe to stay on Lamictal long-term. Exactly how long you take the medication will be up to you and your mental health care professional.

Side effects of Lamictal

All medications come with a risk of side effects, but for the most part, Lamictal is usually well-tolerated with minimal side effects, Streeter says. However, when you’re first starting Lamictal, Streeter says you may experience some side effects like:

• Headache
• Nausea or vomiting
• Fatigue
• Dizziness
• Trouble sleeping 

These side effects should subside with time. If you have any bothersome side effects, make sure to report them to your doctor.

The biggest risk and serious side effect of Lamictal is developing Stevens-Johnson syndrome, which is a medical emergency. This side effect is rare but important to be aware of. It starts out as a rash and can lead to other complications. If you develop a rash while taking Lamictal, contact a medical professional immediately. Your risk of this complication is higher if you take the medications Depakene (valproic acid) or Depakote (divalproex sodium). Make sure your doctor is aware of all medications you take, including over-the-counter medications, supplements, and vitamins. 

Can your mood stabilizer interfere with birth control?

When it comes to Lamictal and hormonal birth control, there’s an important interaction to consider. In essence, studies show that birth control methods with estrogen can impact Lamictal. However, at the usual doses in most people, Lamictal does not significantly impact your birth control, Holland says. It is always best to make sure to talk to your doctor about your medications and how they may or may not interact.

The estrogen in some birth control methods — including some oral contraceptives (birth control pills), contraceptive patches, contraceptive rings, and contraceptive injections — can affect how your body metabolizes Lamictal. Holland says you may need to take a higher dose of Lamictal if you use a birth control method with estrogen since the method might make the Lamictal less effective. According to the FDA, hormonal contraceptives can decrease the concentration of Lamictal in your body by 50%. 

As mentioned, this is only a concern with hormonal birth control methods that contain estrogen, but it’s not an issue with non-hormonal or progestin-only birth control methods, such as progestin-only birth control pills (known as the mini pill), contraceptive implants, hormonal intrauterine devices, and more. 

If you use a form of birth control with estrogen, like a combined oral contraceptive pill, make sure you let your psychiatrist know so they can adjust your dose accordingly. On the flip side, if you’re on Lamictal and plan on stopping your hormonal contraception, you should also tell your provider since your dose may need to be decreased. 

Other treatment options for depression

Lamictal isn’t the right fit for everybody. There are plenty of medications used for treating depression. Your provider will decide what’s the best fit for you upon learning about all your symptoms and medical history. Other prescription medications for depression include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin and norepinephrine reuptake inhibitors (SNRIs)
• Tricyclic antidepressants
• Atypical antidepressants
• Monoamine oxidase inhibitors (MAOIs)

Each class of these medications works differently to target neurotransmitters (chemical messengers in the brain) that are involved in depression. 

Another very important aspect of depression treatment is psychotherapy, also known as talk therapy. While medication certainly plays a role in alleviating symptoms by targeting neurotransmitters and chemical imbalances in the brain, therapy provides important insight, tools, and strategies for managing the day-to-day cognitive and emotional symptoms of depression.

Through therapy, you can learn coping skills, identify and reframe negative thought patterns, address past trauma, and much more. Commonly used therapy modalities for depression are:

• Cognitive behavioral therapy
• Interpersonal psychotherapy (IPT)
• Motivational interviewing
• Psychodynamic Therapy
• Dialectical Behavior Therapy

For most people, a combination of medications and talk therapy is the most effective approach to achieving long-lasting relief from depression. 

Medication management at Charlie Health

If you or a loved one are struggling with depression, Charlie Health is here to help. Charlie Health’s virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for teens, young adults, and families dealing with serious mental health conditions, including depression, bipolar I, bipolar II, and more. 

Our clinicians incorporate evidence-based therapies into individual counseling, family therapy, and group sessions. We offer medication management to clients as needed. With a combination of medication and therapy, feeling better is within reach. Fill out the form below or give us a call to start healing today.