What is Lamictal (Lamotrigine) and How Does it Help Manage Bipolar Disorder?

As you may already know, Lamictal changed and saves my life.  It’s the only drug I’ve been able to take since I was diagnosed in 1995. I am always singing the praises about the drug.

It comes with side effects for sure-   the main one being a rash that can be serious. But it’s very, very rare.  Many health care professionals are wary of Lamictal because of the rash, but I always remind people that a potential side effect is just that. If monitored correctly, the potential is small. Also, the rash is normally benign. Make sure your prescriber knows all of the history before saying no to prescribing Lamictal or Lamotrigine. A rash doesn’t mean you can’t take the drug. It often means you just need to start with a lower dose and increase is slowly.

What is Lamotrigine?

The generic form of Lamicatal is called Lamotrigine.  Lamictal is the brand name and is still prescribed. If you search under the word ‘generic’ you can read  my stories of woe regarding the generic form.  It didn’t work for me at all and I went back to brand name Lamictal. If Lamotrigine works for you, that is fantastic as it’s very cheap. If you try it first and it doesn’t work, defintely ask about the brand name Lamictal. Insurance companies will usually allow the brand change if your prescriber explains why.

For most, the generic is just fine. My mother takes Lamotrigine with very few side effects and great results.

In my experiences with my clients as well as my own experience with myself and family members, Lamictal has many, many more benefits than being a mood stabilizer for bipolar depression. I have seen the following benefits for many years:

Benefits of Lamictal

1. It works extrememly well for irritation and mild aggression.  It’s especially effective for negativity.

2. Rapid cycling. Though this is not talked about as much, Lamictal reduces my rapid cycling by at least 50%.

3. Hypomania- the milder mania from Bipolar two.  Lamictal is not an anti mania drug- this is why people with bipolar one almost always take Lithium, Tegretol, Depakote and or an antipsychotic such as Seroquel, Ability, Risperdol or Zyprexa to manage the mania along with the Lamical for depression.  I have bipolar II and belive me, Lamictal helps my hypomania!

4.  Mild psychosis.  Lamictal keeps me more in touch with reality! It doesn’t have strong anti psychotic benefits, but it defintely helps my paranoia.

I’ve seen it change the lives of so many people! I suggest that anyone who is having trouble with bipolar disorder symptoms at least try Lamictal. As mentioned before, it can be started at a super low dose in order to minimize side effects and then kept at an effective dose for a very long time.  It’s considered the least side effect heavy of any bipolar disorder medication.

I have been on Lamictal since 2005. I defintely have side effects off and on from a stiff neck to itching and twitching! When my dose gets too low- I twitch ‘like a maniac!’ as my friend Pam once said. She really found me amusing! It has also stopped working for me before and my dose had to be significantly increased.  The average dose is 250 mg.  My mom takes 125 mg and I take 700 mg!  Making sure it’s dosed correctly is essential as the range of doses is so high.

I just got this comment from Lin:

Hi, my daughter has taken Lamictal for siezures for many years with no side effects. We had just increased her dose and she started developing tics and high anxiety . Her Neurologist said they are both side effects.Hope this helps.

All drugs have side effects, even aspirin. But I always, always look at the payoff of the drug. If it helps more than it has side effects, I am up for it.

If you are having a hard time or if someone you love is having a hard time, it’s always a good idea to talk to a prescriber about Lamictal.

It can change a life!

Julie

42 comments to What is Lamictal (Lamotrigine) and How Does it Help Manage Bipolar Disorder?

  • Gail

    Julie
    I agree with you so much. Lamotrigine made a huge change for me. My pdoc informed me about the rash and told me she would start with a very low dose and increase at a very slow pace to prevent that from happening. She was so great and that dreaded rash never happened and the drug was made for me. The only side effect that I have is that I am constantly wiggling my tongue, but that is not noticeable to anyone but me. I hope other people will get the chance to try this medication and have it work for them I really think it saved my sanity.

  • Lamictal has also changed my life. Thankfully it was the first drug that my doctor prescribed to me when I was diagnosed 6 years ago and I have been on it since then. Occasionally I will add another drug for a particular up or down cycle, but for the most part, I remain consistently stable on this medication. I also tried the generic and it was not good at all, but once my doctor wrote my insurance company, they approved covering the name brand again. Thank you for sharing!

  • My understanding is that it’s always recommended to start with a very low dose of Lamictal and slowly increase it to avoid the rash. Lamictal works great for my hypomania, which in the past had increased to full-blown mania without treatment. I still get depressed but would be much worse without the medication, and the only time I really have hypomania is when my body chemicals change (usually just “PMS” time or times of high stress).

    When I was first diagnosed my NP prescribed Lithium. It made me thirsty all the time and made my mouth feel all hot and tingly and strange. I was having hot flashes and sweating a lot on Lithium, and I was extremely manic. Lamictal has been so much better, with just some dose changes here and there. I was taking 300 mg of Lamictal at first. My NP lowered the dose to 250 mg, and when I mentioned that I was feeling rather dull and stupid she lowered the dose to 200 mg and I smartened up a bit!

    I’m an itchy person to begin with because I’m allergic to pollen and house dust, so I’m not sure if Lamictal contributes to my itchiness. I’m also wiggly and find it hard to get comfortable and sit still, but I’ve always had neck and back pain so that might not be caused by the Lamictal either. I have some twitches and shaking in my hands during PMS/high stress times. But overall, the benefits far outweigh any itchies, twitchies, or wigglies!

  • Aha, I didn’t know that the closed throat thing was related to Lamictal! I have the yawning and shortness of breath too, but I also have asthma so I thought that was the problem. I agree, personal experience stories are so helpful!

  • Cee

    I did the slow dosage increase that you’re supposed to do. I was doing very well on lamotrigine when I was at 100mg. I was doing so well moodwise, I figured if 100mg was good, 150 mg would be better and 200mg would be even better than that. Not so for me. I had been having a few problems with concentration and memory over the years due to depression. At 150mg these problems increased and I often forgot words I wanted to use when I was talking. I could fake it by using other ways of saying things but sometimes I know the way I talked sounded pretty peculiar. I also started becoming clumsy and losing my balance slightly when I walked. Nothing too bad but I did notice it. At first I didn’t know that it was the medication that was causing the balance problems. I asked my psychiatrist and he said it was possible it was the lamotrigine. He laughed when I said I would have to fall on my face before I would think of reducing my dose. A couple of months later after a relapse into depression, my pdoc increased my dose to 200mg (supposedly the therapeutic dose). It has been three weeks now and my memory, concentration and balance problems have increased dramatically without my depression lifting all that much. I haven’t fallen on my face yet , but next week when I go for my med check, I’m going to ask to have my dose reduced. Needless to say, I am very disappointed I didn’t respond better. Everything was going along so well at first.

  • Cee, I have the lost words thing too, and I never thought of it being caused by Lamictal. I used to have such a great vocabulary! I get the wobblies as well. My legs just don’t seem to be where I think they are and I stub my toes a lot. I find I’m more balanced and don’t run into things as much when I wear my Vibram FiveFingers shoes (they are a “barefoot” shoe, I like the “Jaya” model best so far). My memory and concentration aren’t what they used to be, but they did get better with the reduced dose. I hope you can find a dose that works for you. :-)

    Julie, thanks again for this post – I’ve been learning a lot too!

  • Nancy Thomas-Rohlfer

    All of this information has been extremely helpful. I have tried several medications and nothing is lifting my depression. I am currently on Cymbalta 60mg. I believe it is helping with my anxiety but is somehow contributing to my depression. My doctor has just diagnosed me with treatment resistant depression. I am thinking about suggesting Lamictal to him but am concerned about being label with “bipolar” and also about having a “flat” affect”. Has anyone experienced a dulling mood while on Lamictal?
    Nancy

    • Hi Nancy,

      You can tell how much I love Lamictal. It saves my life. I have not experienced any flat feelings. That tends to be more with lithium and some of the anti psychotics. In general, Lamictal has the least side effects of all bipolar disorder depression medications.

      Lamictal is used for bipolar and unipolar depression. My mom is on it and doesn’t have bipolar disorder. There is no need to worry if someone will think you have bipolar if you take the drug. If you say Lithium, well… most people will assume it’s bipolar, but people with depression sometimes take lithium as well.

      Every person I know who has responded well to Lamictal says it’s the best drug they have ever tried. It really is that amazing when it works. I know hundreds of people on Lamictal and have heard all kinds of side effects that are not common- such as getting manic (rare)- a serious rash (very rare!) and muscle problems such as a stiff neck and twitching. Outside of the rash, the side effects for most people are so mild it’s amazing.

      Lamictal was my 23rd drug. So never give up!

      Julie

      PS: If you go to the search box in the upper right corner and type in Lamictal- you can read more than you ever thought possible on the topic! I suggest you read all you can about the rash- as it’s rarely as serious as people think. If you start the drug slowly and titrate up on the dose, you should be fine. A prescriber can help you with this. Good luck! Please let me know how it goes.

    • Elizabeth Casto

      I am experiencing flat affect right now on it. I have only been on it for 2 weeks. I started it on a hypomanic episode and it slowed everything down and i still felt great.Now I feel like I’m dead on the inside and my soul is being sucked out of me. I cry at work now when I never used to. I am on 50mg ATM and the dose change has seemed to mess with me emotional. I feel like a wreck. All I want to do is sit in a dark corner away from everyone. But I cannot do that with a customer service job. My life is hell. I think I will need another antidepressant to level out.

      But everyone is different on meds. So you never know and maybe I will get better with an even higher dose who knows?

      • Nancy Thomas-Rohlfer

        So sorry to hear that you are feeling dead inside and that your soul is being sucked out of you!!!! I am just now starting to come out of my dark corner after being in it for over 3 months. You are not alone! I always feel alone when I am in those deep depressions. I try to reach out to people but they just don’t get it and they judge me which makes me want to isolate myself even more even though I know that is the worst thing I can do!!! Being in a customer service job is very difficult when you are feeling depressed!!! I had to quit my job because it was too stressful. I am trying to get help through Vocational Rehab so that I can find a better job that suits who I am.I have tried to reach out to services I qualify for so I can join a support group that understands what I am going through. I have an appt this Friday so I will see how it goes.

      • Sarah

        Hi Elizabeth & Nancy,

        I really think that having a customer service job contributes to depression A LOT. I’ve been working in call centers for most of my career, and sometimes I really hate it. For years, I actually thought I didn’t want to work, that I wanted to be a stay-at-home mom, and I resented having to work. But really, it’s what you have to do at work that makes it suck so bad. When I first got diagnosed w bipolar 2, I was on lamictal and abilify. I had incidences of rage, so every time I’d get angry, I’d pressure my pdoc to up my doses, until they were too high. And then I didn’t mind going to my call center job, but I was very flat, and my family didn’t like that. I just started lamictal again after 2 years being off both meds. I am going to try to keep the dose lower. Since I’ve been working cognitively with my therapist, I really don’t get angry like I used to. So, we’ll see. Call center jobs provide the highest pay I can get at my level of education, so that’s why I work in them. But it totally blows. I went back to college, because I’ve got to get out of this profession.

  • Nancy

    Thanks so much Julie this was very helpful!!! Can you tell me if there has been a lot of weight gain reported while taking Lamictal? I gained 40 lbs while on an anti-depressant. I have lost all of that weight and do not want to gain it back!!!
    Nancy

    • Hi Nancy,

      I’m glad I could help! I have never gained weight with Lamictal and don’t know anyone who has. (There are always exceptions- but weight gain is not the norm with Lamictal)

      I have gained weight from Trilafon, Risperdol, Seroquel, over the counter NAC amino acids, Depakote and Tegretol. But not Lamictal.

      julie

  • Cee

    Nancy, this is a follow up from my previous comment. When I went back down to 150mg, I was better. I guess everyone just has to find the dose that works best for them. As far as “flat affect” is concerned, I find that it just chops off the worst parts of the depression but doesn’t seem to flatten out the good times much. I’ve always had way more depression than hypomania, so I sure appreciate that. I don’t cry at the drop of a hat like I used to. There’s been no weight gain either.

  • Holland

    I am currently taking Lithium 1200mgs (probably will go up to 1500mg soon to stay in therapeutic range) Seroquel 200mg and we are fazing out my citalipram. How would I go about trying Lamictal? I tried it once, but got a rash. So we just stopped it. I can’t remember the dose.
    I am really concerned about the possible weight gain with Seroquel, because I am already overweight and health wise can not afford to gain weight.
    I had a rough summer about 8 weeks of deep depression including 2 weeks in the psyc hospital and over 8 weeks of hypomania into mania. Just trying hard to get stable.

  • Eunice

    Hi Julie,

    Can your tell me how you ended up at 700mg? My daughter takes 300, I don’t think it does very much for her. But I doubt the doctors would go higher. And how would you know if the Lamictal name brand worked over the generic? What doctor would prescribe it if generic lamotrigine didn’t work?

    My daughter is on lithium, lamictal, Trileptal, Xanax and more, but she still has daily cycles that are hard to control.

  • Cheryl

    My boyfriend just started taking this about a year ago and his doctor only has him on 40 mg and it’s just not enough. After almost 20 years of refusing to take meds this is progress for sure, but both he and his doctor are being so very conservative I’m still waiting for the miracle to kick in. Don’t get me wrong, even at 40 mg it’s helped, but there is still irritably, cycling, sleeplessness, etc. His mom is at 400 mg so at least in theory he should be able to tolerate a higher dosage. How does one call attention to this issue without seeming to do so?

  • christa thurman

    Lamictal changed my life! I was angry and moody ALL THE TIME! Now I am nothing but happy everyday! It’s been 4 years and still working! :)

  • mark

    Julie,
    700 milligrams. I thought 300 was tops. You do know it can cause diabetes? I hope you have your insulin and glucose tested.

    • Hi Mark,

      Lamictal is a very personal drug in terms of dosage. My mom is on 125 while I am on the 700. There is little data at this dose- but it saved me.

      Many, many people take more than 300mg. It’s about how well it works. ALL of these drugs are toxic- all have side effects, but if they save lives- the dosage can get quite high. I discuss all of my meds with my coauthor Dr. John Preston who writes books on psych drugs and we decided on this dose when 500 and 600 were not helping. It has been three years now and I am still here! Julie

      • mark

        My doc wont let me go past 300 thats why I was amazed. I do know my glucose levels did go up and I am now pre diabetic as a result. The warnings on Lamictal discuss diabetes. That was my concern.

        • Thanks Mark. I”m going to talk with my coauthor John in the next few days and will defintely ask him. I have not heard of the 300mg cut off. All docs are different. It only matters that it is helping. Are you only on Lamictal? It is important to know this- but I have never heard this side effect with the drug. I will get back with you. We ALL need to get tested when we are on any psych drug. Julie

    • Oops I forgot to answer you diabetes comment. I’m actually on a diabetes prevention diet due to the meds- my blood sugar/insulin/etc are all normal- but I can’t take any chances. I get my lithium tested regularly as well. My weight is a problem, but my body is holding up. Do you have a link to the info on it causing diabetes? ANti psychotics have the highest risk of diabetes due to metabolic syndrome caused by fat around the stomach. I sometimes call it the seroquel stomach or the spare tire. If you have any information on this, feel free to write it here and I will pass it one! Thanks for your comments. Julie

  • jan

    iam taking lamotrigne for about 3months back it gave me sever sucidial thoughts even attempted iam on 100mg keeps me mum fagtigue lean legs sweting social disconect lack of intrest it is hell by this drug soul is feaking hypo mania was better than this hell

  • curt lee

    I started taking this because I felt like I was under depression and all sorts of mood swings. I was seventeen when I started taking these… After a bit I felt like I did before I was ill… I felt more in-touch with the world. I remember going on a trip at college and forgetting to bring them… and after four days I went back to how I felt before I started taking them… Disconnected from the world, depressed, cried and thought reality was scary… I’m back on them and I feel like I felt before I was ill… Normal. :)

  • I think my body is not made for Lamotrigine. I’ve been on 50-150mg add-ons to my cocktail to treat current state of hypomania rapid cycling. Anything over 50mg sets of tingling / paraphernalia for at least a full day. Complete with purple under my fingernails. I will ask my pdoc if she thinks switching to brand will make a difference. Lamotrigine is my second try for this cycle because Abilify caused a 30 lb weight gain the first month. I am hesitant to change because it seems like just when I get the mix working, I drop off hypomania into the dark side.

  • Hello! Ive been taking Lamictal for 7.5 years and I too have noticted drastic word recall loss. I can’t remember things very well and my mind is becoming like a elderly person’s. I’m only 37. It used to help my depression but I’m now having to add an anti-depressant to my regiment. I’ve been thinking about gping off the Lamictal for a while to see if my brain straightens out any. I have issues with balance and clumsiness as well. I don’t like feeling like this, i want to feel normal and alert again.

    • Hi Aurelius,

      This is totally normal. Many psych drugs affect word use- it makes sense- word use is chemical. Many of my meds have made me feel like a stroke survivor! This side effect comes and goes for me- I can live with it in terms of the Lamictal. I’ve had to stop other drugs due to memory problems though.

      I write a lot about side effects- if your quality of life is terrible- it’s almost like being depressed. We have an unfair dilemma!

      I suggest that you talk with your prescriber about changing the Lamictal dose first. Your body has changed a LOT in seven years.

      If you work with someone and go down slowly- you can find the balance between the Lamictal working and your memory coming back. If you find a place where the side effects are better- but the depression is coming back, adding an anti depressant can work. You have to be very careful though – Lamictal is not an anti mania drug. If you add an anti depressant, you’re definitely at risk for mania. Your prescriber can help with this!

      Here is the good news- I’ve never had permanent memory loss from my meds. It’s always a side effect. Ativan causes me similar problems, but if I keep my dosage low, I am fine.

      I have a lot more to say here and will write a post on this topic soon!

      Julie

  • julie peters

    My daughter is bipolar2 with rapid cycling. She is currently on Abilify and lexapro but she still cycles a lot and we are constantly adjusting her meds. I have been researching lamictal and it looks promising. She also takes metafolate which has changed her life! She had terrible brain fog and memory problems before she started the folate. Probably caused by meds it has cleared and she says she finally feels like herself. I think I read somewhere else that this is supposed to help with the lamictal as well. She had genetic testing done about 2 yrs ago as well (she has a great pdoc, she worked in research before going into practice) the info we gained has really helped with dosing. She takes a very low dose of the Abilify, which is effective and has reduced side effects. I would recommend testing if you can afford it.

  • Merci

    I have been on lamotrigine for many years (at least 7). I take 400mg at night. The worst side effect for me has been the constant peeling of my fingertips and of my ears. The very top of my ears get “crunchy”, like they’ve been sunburned, and it’s very painful to lay on my side to sleep. My doctor looked this up and it is a possible side effect. I need to read about the rash, as recently I’ve developed a terrible one around my ears and hairline. My fingertips are also painful. I can’t tell if the lamotrigine has really helped or not, as I’ve always been on several other meds at the same time. I’m taking Effexor XR and Topirimate along with Alprazolam. This posting has been very helpful, as I have experienced the forgetfulness and clumsiness. Nice to understand why!

  • Steve

    Hi Julie, I was diagnosed w/bipolar back in 84. I’ve primarily been depressed w/high anxiety. I started tapering from nefazodone to lamotrigne about 6 weeks ago. I am now on 100 mg lamotragine. For the 1st time in my life I felt real happiness. I actually looked forward to waking up in the mornings. Even my terribly depressing dreams disappeared. Sad to say it only lasted about 2 weeks – the gray skies are back. Can you speak to this? Have I developed a tolerance or ?????
    Any info you can provide will be appreciated – Thanks

  • ally

    I have been on lamictal for about a month and a half ive been taking 100mg for about 3-4 weeks notw and im starting as well as everyone else thst im way more irritated angry mean and short with people. Has this happened to anyone. Could I need a higher dose. My moods have been more stable. Not as many swings but just seem so angry all the time. any help?

  • Lucy

    Hello, just wanted to share my experience with adding Lamactil after MANY years of going from one anti-depressant to another. It definitely has changed my life. Like others have said, I finally really feel happy and look forward to getting up in the morning! I am only on 100 mg. and 40 mg. of Fluoxetine. I have the lack of the right word syndrome and also am spilling things MUCH more often than before. I googled and this is the site it gave me for “Lamactil and clumsiness”. Thanks for making me feel better! I get embarrassed about the spilling things and knocking things over! BUT like others have said, it’s worth it..totally.

  • Amanda

    Greetings! thank you so much for this blog! I just started lamictol about a month ago to replace Gaba Pentin because it was making me tired, groggy, and feeling kind of flat. I’m still on it as I’m increasing the lamictal, which is a generic. I increased from 25mg, to 50mg, to 100mg starting about a week ago. I haven’t noticed any benefits yet, but I’ve had nausea, stomach cramps, and pretty bad diahrrea. I’m wondering if those stomach symptoms will go away after a bit. I would certainly like a med that doesn’t make me so tired and groggy, We started the Gaba Pentin to help with racing thoughts and paranoia, which it does help with for sure. It also helps with negative thinking and toxic shame. If lamictal can help with those things, and help me be more clear-headed, I’d love that, I’m just hoping the stomach symptoms are temporary, and that I’ll be able to start feeling its benefits soon. Any thoughts/experiences? Thanks again!

  • Bob

    I am BP2 with a tendency to be on the depressive side more than the manic side. Lamictal (lamotrigine) works best for me. I currently take 300 mg per day. But Lamictal is just a base line med for me for management. I’ve found that I need to exercise at least 2 days per week at a minimum (preferably more), get sunlight during the winter (tanning bed – yeah I know), and take various other supplements (Magnesium Citrate, 5htp, niacin, EPA, zinc, multivitamin, apple cider vinegar, L-Tyrosine, L-Glutamine, GABA) that I keep tweaking all the time. This is a condition that definitely needs to be managed. There are so many things can be stressors that trigger episodes so you need to pay attention to what sets you off. Is it conflict at work? Is it attending a funeral or memorial service for a friend or loved one? Pay attention and observe your behavior. Hang in there with the lamictal. Keep working with your doc to tweak it up to the dosage that works for you without moving too quickly. You’ll know when you’ve boosted too much too soon. Listen to your body. For energy, the best single thing you can do is exercise! Even walking several days each week for 20 to 30 minutes will make a world of difference. My faith plays a huge role as well as I continually renew my mind to improve my thinking daily. Just remember, you’ll always be refining your management of your condition. You’re not going to find a magic formula that will work forever all the time. This is a life long pursuit. Enjoy the journey!

  • dom

    I went on lamictal for 5 months. the first three were wonderful, my anxiety levels were down but by the 4th and 5th month I started feeling like I was doing some impulsive things that I hadn’t done before. I became very very irritable and argumentative. I also started feeling emotions less. I’m had a problem climaxing at all when I had sex with my wife.my vision was foggy i gained about 10 pounds because for some reason I was hungry all the time. I also felt my heart racing at strangest times, when I was laying down in bed.I was at 100 milligrams, it works for a while but then quickly dissipated and quite frankly I felt tired, not rested and just didn’t feel myself. Over the course of 3 weeks slowly then I finally did get off for about 3 days I had the worst headache and all I could do was sleep. I’m starting to feel a little more energetic as the days go on. This is where I’m at.

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