FAQ: Psychiatric Uses of Lamotrigine
(Lamictal).


1. What is lamotrigine (Lamictal)?

Lamotrigine is an anticonvulsant that is chemically unrelated to any other anticonvulsant or mood regulating medication.


2. When was lamotrigine approved for marketing in the USA and for what indications may it be promoted?

Lamotrigine received final approval for marketing in the USA on 27 December 1994 and was labeled for use as an anticonvulsant. In 2003 it was approved by the FDA for use as a treatment for people with bipolar disorder.


3. Is a generic version of lamotrigine available?

Generic lamotrigine is available in the USA. There are a number of manufacturers. While most generic versions are generally effective, many individuals taking the generic manufactured by TEVA have found it to be unsatisfactory when they were forced to take it by their insurnace companies.


4. How does lamotrigine differ from other mood stabilizing drugs?

Lamotrigine differs from other mood stabilizing drugs in two major ways

1. Lamotrigine's frequent effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;

2. Lamotrigine's relatively benign side-effect profile.


5. What, if anything, uniquely distinguishes lamotrigine from carbamazepine and valproate?

Lamotrigine has been successful in controlling rapid cycling and mixed bipolar states in people who have not received adequate relief from lithium, carbamazepine and/or valproate. It also appears that lamotrigine has significantly more antidepressant potency than either carbamazepine or valproate.

Lamotrigine is also useful as part of the treatment of some people with major (unipolar) depression.

Lamotrigine has recently been reported to be a useful treatment for some people with post-traumatic stress disorder (PTSD) and/or borderline personality disorder (BPD).


6. People with what sorts of psychiatric disorders are candidates for treatment with lamotrigine?

It is too early to be very specific about which mood disorders are most likely to respond to treatment with lamotrigine. Patients with hard-to-treat bipolar syndromes and with schizoaffective disorder have been treated more often than patients with "treatment-resistant" unipolar disorders. Some people with such hard to treat unipolar depressions have been treated with good results. Some patients diagnosed with Borderline Personality Disorder, a disorder that many psychiatrists believe is a variant of Bipolar Disorder, have responded to treatment with lamotrigine. Patients with Post-Traumatic Stress Disorder and with Depersonalization Disorder have also responded well to lamotrigine therapy.


7. Is lamotrigine useful for the treatment of acute depressed, manic and mixed states, and can it also be used to prevent future episodes of mania and/or depression?

The initial use of lamotrigine was to treat people with depressed, manic and mixed states that did not respond to existing medications. Some patients are now being maintained on lamotrigine on a long term basis in an attempt to prevent future episodes. Evidence regarding the effectiveness of lamotrigine as a long-term prophylactic agent is increasing.


8. Are there any laboratory tests that should precede the start of lamotrigine therapy?

Before lamotrigine is prescribed the patient should have a thorough medical evaluation, including blood and urine tests, to rule out any medical condition, such as thyroid disorders, that may cause or exacerbate a mood disorder.


9. How is treatment with lamotrigine initiated?

In people not taking carbamazepine or valproate, lamotrigine is usually initially prescribed at an initial dose of 12.5 or 25 mg a day and the dose increased by 12.5 or 25 mg every week or two.

In people taking valproate the initial dose of lamotrigine is often 12.5 mg/day and the drug is increased by 12.5 mg every ten days or two weeks.

In people taking carbamazepine somewhat larger initial doses and more rapid increases in dose are possible.


10. Are there any special problems prescribing lamotrigine for people taking lithium, Tegretol, or Depakote?

An interaction between lithium and lamotrigine has not been reported.

Carbamazepine induced enzymes that facilitate the metabolism of lamotrigine. Because of that, blood levels of lamotrigine are somewhat lower in people taking carbamazepine than in those not taking carbamazepine.

Valproate has the ability to double plasma levels of lamotrigine. Because of that, when lamotrigine is started in people taking valproate, the initial dose should be approximately one-half as much as is usually initially prescribed.


11. What is the usual final dose of lamotrigine?

When used as an antidepressant or as a mood-stabilizing agent the final dose of lamotrigine is most often between 100 and 200 mg/day. Some people require doses as high as 600 mg/day to achieve a good antidepressant effect. Such doses should be avoided in patients taking valproate because of the pharmacokinetic effect of valproate that increases plasma levels of lamotrigine, and the accompanying increased risk of serious dermatological side effects.


12. How long does it take for lamotrigine to 'kick-in?'

While some people notice the antimanic and antidepressant effects early in treatment, others have to take a therapeutic amount of lamotrigine for up to a month before being aware of a significant amount of improvement.


13. What are the side-effects of lamotrigine?

Here is a listing of lamotrigine's side effects that affected 10% or more of the 711 people taking the drug during clinical trials and the frequency of those side effects in the 419 people treated with placebo in those trials

                                Adverse Reactions (%)

          Adverse Reaction    Lamotrigine         Placebo

          Dizziness                38                13
          Headache                 29                19
          Double Vision            28                 7
          Unsteadiness             22                 6
          Nausea                   19                10
          Blurred Vision           16                 5
          Sleepiness               14                 7
          Rash                     10                 5
          Vomiting                 10                 4

Side-effects are most noticeable the few days after an increase in dose and then usually fade.

14. Which side-effects are severe enough to force people to discontinue lamotrigine? Are sexual side-effects a problem?

The side-effect of lamotrigine that most often causes the drug to be discontinued is a rash. Rashes can be mild, similar to a slight sunburn, or can be quite severe resembling a severe case of poison-ivy. The more severe the rash the less likely it is that the individual will be able to continue the medication. ALL rashes should be immediately reported to the physicians prescribing the lamotrigine.

About one in ten people taking lamotrigine develops a mild rash and about 1 in a thousand develop a severe rash requiring treatment. Many people with a mild rash can continue to take lamotrigine, sometimes together with an antihistamine.

A rash is more likely to develop when the initial doses of lamotrigine are high or when lamotrigine is too rapidly started when someone is taking valproate.

It is important that people taking lamotrigine who develop a rash immediately contact their physician as there have been a few deaths in people who have developed lamotrigine-induced rashes (Stevens-Johnson syndrome).

Sexual side-effects are not a problem with lamotrigine.


15. Does lamotrigine have any psychiatric side effects?

Among the rarely reported side effects of lamotrigine are agitation, anxiety, concentration problems, confusion, depression, emotional instability, irritability, and mania.

Mania or hypomanic induced by lamotrigine responds well to treatment with lithium or small doses of topiramate.


16. How does lamotrigine interact with prescription and over-the-counter medications?

Only a few interactions between lamotrigine and other drugs have been identified. Lamotrigine increases the plasma level of carbamazepine and its metabolites. Carbamazepine lowers the concentration of lamotrigine in the blood.

Valproate doubles the plasma level of lamotrigine, and the level of valproate is decreased by about 25% in people taking lamotrigine.

Phenobarbital and primidone lower the plasma level of lamotrigine by about 40%.

Oral contraceptives can lower the plasma level of lamotrigine by as much as 50%.

Interactions with other prescription and over-the-counter drugs are not known at this time.


17. Is there an interaction between lamotrigine and alcohol?

Alcohol may increase the severity of the side-effects of lamotrigine.


18. Is lamotrigine safe for a woman who is about to become pregnant, pregnant or nursing an infant?

Lamotrigine is has been placed in the FDA pregnancy Category C

"Animal studies have shown an adverse effect on the fetus but there are no adequate studies in humans; The benefits from the use of the drug in pregnant women may be acceptable despite its potential risks . . . ."

An increasing number of women with epilepsy are continuing lamotrigine throughout their pregnancies. Research on the effects of lamotrigine on their children is underway.


19. Is lamotrigine safe for children and adolescents?

While lamotrigine has been used with children and young adolescents in other countries. In the USA, because of the increased risk of fatal side-effects in the young, lamotrigine is only approved for use in those over the age of 16.


20. Can lamotrigine be used in elderly people?

Older people seem to handle lamotrigine similarly to younger ones. There is little experience using lamotrigine for the treatment of psychiatric disorders in the elderly.


21. Do symptoms develop if lamotrigine is suddenly discontinued?

There are no specific symptoms that have been described following the abrupt discontinuation of lamotrigine, other than the seizures that sometimes follow the rapid discontinuation of any anticonvulsant. Only when necessary because of a serious side effect, should lamotrigine be suddenly discontinued.


22. Is lamotrigine toxic if taken in overdose?

Data on overdoses are scarce. Two individuals who took over 4,000 mg of lamotrigine survived without long-lasting effects.


23. Can lamotrigine be taken along with MAO inhibitors?

Yes, the combination has been used without any special problems.


24. What does lamotrigine cost?

As of 4 April 2011, the per tablet cost of Lamictal brand lamotrigine, when ordered in lots of 100 tablets from a well-known mail-order pharmacy (Drugstore.com) was:

25 mg - $4.83
100 mg - $5.43
150 mg - $5.93
200 mg - $6.67

The per tablet cost of generic lamotrigine is:

25 mg - $0.30
100 mg - $0.30
150 mg - $0.53
200 mg - $0.53


25. Might lamotrigine be effective in people who have failed to receive benefit from other psychopharmacologic agents?

The major psychiatric use of lamotrigine is with people who have mood disorders that have not been adequately controlled by other medications.


26. What are the advantages of lamotrigine?

Lamotrigine seems to be effective in about two-thirds of people with bipolar mood disorders that have not responded to lithium or other mood-stabilizers. Some people who have not been able to tolerate any antidepressant because of switches to mania or increased speed or intensity of cycling, or because of the development of mixed states, have been able to tolerate therapeutic doses of anti- depressants when taking lamotrigine.

For most people, lamotrigine has minimal side effects and can be taken once a day.

Lamotrigine is also useful as a potentiating agent for antidepressants being used to treat people with major (unipolar) depression.


27. What are the disadvantages of lamotrigine?

As lamotrigine has only been available for a relatively short time, it was first marketed in 1990, there is no information about long term side-effects. As its use with people with mood disorders started even more recently, it is not known if people who initially do well on lamotrigine continue to do so after many years of treatment.

As with other medications with antidepressant activity, lamotrigine occasionally causes people to become hypomanic or manic. This can usally be controlled by small doses of lithium or topiramate.

There is a small chance of a serious, and in some cases life-threatening, rash developing in people taking lamotrigine. This side effect is more frequently seen in those under the age of 16 than in older persons.


28. Why should physicians prescribe, and patients take, lamotrigine, when there are mood regulating medications that have been available for many years?

There are two major reasons why physicians prescribe and patients take lamotrigine rather than older medications. They are that not everyone benefits from treatment with the older, better known drugs, and that some people find the side effects of the older drugs to be unacceptable.


29. Is lamotrigine available in countries other than the USA?

Lamotrigine is currently available in about 60 countries.


30. Where might one read in detail about lamotrigine and its use in treating people with mood disorders?

The most authoritative places to read about the psychiatric uses of lamotrigine are:

Treatment of Bipolar Illness: A Casebook for Clinicians and Patients

Handbook of Diagnosis and Treatment of Bipolar Disorders

Depression and Bipolar Disorder: Stahl's Essential Psychopharmacology, 3rd edition


31. Has anything been published on the use of lamotrigine as a therapeutic agent for people with mood disorders?

Here are some bibliographic references on the use of lamotrigine for the treatment of people with mood, and other psychiatric, disorders:

Asghar SA. Related Articles European Psychiatry, 2002, 17 (Suppl 1) 109. Case report of 5 bipolar disorder patients (Rapid Cycling) followed for 3 years, treated with lamotrigine.
[MEDLINE abstract

Barbee JG, Jamhour NJ.
Journal of Clinical Psychiatry, 2002, 63, 737-741.
Lamotrigine as an augmentation agent in treatment-resistant depression.
[MEDLINE abstract]

Barbosa L, Berk M, Vorster M.
Journal of Clinical Psychiatry, 2003, 64, 403-407.
A double-blind, randomized, placebo-controlled trial of augmentation with lamotrigine or placebo in patients concomitantly treated with fluoxetine for resistant major depressive episodes.
[MEDLINE abstract]

Berk, M
European Neuropsychopharmacology, 1999, 9 (Suppl 4) S119-S123..
Lamotrigine and the treatment of mania in bipolar disorder.
[MEDLINE abstract]

Botts SR & Raskind J
American Journal of Health System Pharmacy, 1999, 56, 1939-1944..
Gabapentin and lamotrigine in bipolar disorder.
[MEDLINE abstract]

Bowden CL Neuropsychopharmacology, 1998, 19, 194-199.
New concepts in mood stabilization: evidence for the effectiveness of valproate and lamotrigine.
[MEDLINE abstract]

Bowden CL, Calabrese JR, McElroy SL et al.
Biological Psychiatry, 1999, 45, 953-958.
The efficacy of lamotrigine in rapid cycling and non-rapid cycling patients with bipolar disorder.
[MEDLINE abstract]

Bowden CL, Calabrese JR, Sachs G, et al.
Archives of General Psychiatry, 2003, 60, 392-400 .
A placebo-controlled 18-month trial of lamotrigine and lithium maintenance treatment in recently manic or hypomanic patients with bipolar I disorder.
[MEDLINE abstract]

Bowden CL, Karren NU.
Expert Opinion in Pharmacotherapy, 2002, 3, 1513-1519.
Lamotrigine in the treatment of bipolar disorder.
[MEDLINE abstract]

Bowden CL, Mitchell P, Suppes T
European Neuropsychopharmacology, 1999, 9 (Suppl 4) S113-S117.
Lamotrigine in the treatment of bipolar depression.
[MEDLINE abstract]

Brambilla P, Barale F, Soares JC.
International Journal of Neuropsychopharmacology, 2001 4, 421-446.
Perspectives on the use of anticonvulsants in the treatment of bipolar disorder.
[MEDLINE abstract]

Brown ES, Nejtek VA, Perantie DC, Orsulak PJ, Bobadilla L.
Journal of Clinical Psychiatry, 2003, 64, 197-201.
Lamotrigine in patients with bipolar disorder and cocaine dependence.
[MEDLINE abstract]

Calabrese JR, Bowden, CL, Sachs GS, et al.
Journal of Clinical Psychiatry, 1999, 60, 79-88.
A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar depression.
[MEDLINE abstract]

Calabrese JR, Bowden CL, McElroy SL, et al.
American Journal of Psychiatry, 1999 156: 1019-1023.
Spectrum of Activity of Lamotrigine in Treatment-Refractory Bipolar Disorder.
[MEDLINE abstract]

Calabrese JR, Fatemi SH, Woyshville MJ
American Journal of Psychiatry, 1996, 153, 1236.
Antidepressant effects of lamotrigine in rapidly-cycling bipolar disorder.
[No MEDLINE abstract available]

Calabrese JR & Gajwani P
American Journal of Psychiatry, 2000, 157, 1523.
Lamotrigine and clozapine for bipolar disorder.
[No MEDLINE abstract available]

Calabrese JR, Rappoport DJ, Kimmel SE et al.
European Neuropsychopharmacology, 1999, 9 (Suppl 4) S109-S112.
Controlled trials in bipolar I depression: Focus on switch rates and efficacy.
[No MEDLINE abstract available]

Calabrese JR, Rappoprt DJ, Shelton MD, et al.
Neuropsychobiology, 1998, 38, 185-191.
Clinical studies on the use of lamotrigine in Bipolar Disorder.
[MEDLINE abstract]

Calabrese JR, Shelton MD, Rapport DJ, et al.
Journal of Clinical Psychiatry, 2002, 63 (Suppl 3), 5-9.
Bipolar disorders and the effectiveness of novel anticonvulsants.
[MEDLINE abstract

Calabrese JR, Shelton MD, Rapport DJ, et al.
Journal of Clinical Psychiatry, 2002, 63 (Suppl 10). 18-22.
Long-term treatment of bipolar disorder with lamotrigine.
[MEDLINE abstract]

Calabrese JR, Shelton MD, Rapport DJ, Kujawa M, Kimmel SE, Caban S.
Journal of Affective Disorders, 2001, 67, 241-255.
Current research on rapid cycling bipolar disorder and its treatment.
[MEDLINE abstract]

Calabrese JR, Sullivan JR, Bowden CL, et al.
Journal of Clinical Psychiatry, 2002, 63, 1012-1019./I>
Rash in multicenter trials of lamotrigine in mood disorders: Clinical relevance and management.
[MEDLINE abstract]

Calabrese JR, Suppes T Bowden CL et al,>
Journal of Clinical Psychiatry, 2000, 61, 841-850.
A double-blind, placebo controlled, prophylaxis study of lamotrigine in rapidly cycling bipolar disorder.
[MEDLINE abstract]

Calabrese JR, Vieta E, Shelton MD.
European Journal of Neuropsychopharmacology, 2003, 13 (Suppl), 2. 57-66.
Latest maintenance data on lamotrigine in bipolar disorder.
[MEDLINE abstract]

Chaudron LH, Jefferson JW
Journal of Clinical Psychiatry 2000, 61, 79-90.
Mood stabilizers druing breastfeediung: A review.
[MEDLINE abstract]

Chen C, Veronese L, Yin Y.
British Journal of Clinical Pharmacology, 2000, 50, 193-195.
The effects of lamotrigine on the pharmacokinetics of lithium.
[MEDLINE abstract]

Crawford P, Brown S, Kerr M.
Seizure, 2001 Mar;10(2):107-15.
A randomized open-label study of gabapentin and lamotrigine in adults with learning disability and resistant epilepsy.
[MEDLINE abstract]

Devarjan S, Dursun SM
American Journal of Psychiatry, 2000, 157, 1178.
Aggression ain dementia with lamotrigine treatment.
[No MEDLINE abstract available]

Dunn RT, Frye MS, Kimbrell TA, Denicoff KD, Leverich GS, Post RM
Clinical Neuropharmacology, 1998; 21, 215-235..
The efficacy and use of anticonvulsants in mood disorders.
[MEDLINE abstract]

Dursun SM & Deakin JF.
Journal of Psychopharmacology, 2001, 15,297-301.
Augmenting antipsychotic treatment with lamotrigine or topiramate in patients with treatment-resistant schizophrenia: a naturalistic case-series outcome study.
[MEDLINE abstract]

Dursun SM, McIntosh D, Milliken H
Archives of Genral Psychiatry, 1999, 56, 950.
Clozapine plus lamotrigine in treatment-resistant schizophrenia.
[No MEDLINE abstract available]

Engle PM, Heck AM
Annals of Pharmacotherapy, 2000, 34, 258-262.
Laotrigine for the treatment of bipolar disorder.
[MEDLINE abstract]

Erfurth A, Walden J, Grunze H
Neuropsychobiology, 1998, 38, 204-205.
Lamotrigine in the treatment of schizoaffective disorder.
[MEDLINE research]

Ernst CL, Goldberg JF.
Journal of Clinical Psychopharmacology, 2003, 23, 182-192.
Antidepressant properties of anticonvulsant drugs for bipolar disorder.
[MEDLINE abstract]

Ettinger AB, Weisbrot DM, Saracco J, et al.
Epilepsia, 1998, 39, 874-877.
Positive and negative psychotropic effects of lamotrigine in patients with epilepsy and mental retardation.
[MEDLINE abstract]

Fatemi SH, Rapport DJ, Calabrese JR, Thuras P
Journal of Clinical Psychiatry, 1997, 58, 522-527.
Lamotrigine in rapid cycling bipolar Disorder.
[MEDLINE abstract]

Ferrier IN
Neuropsychobiology, 1998, 38, 192-197.
Lamotrigine and gabapentin. Alternatives in the treatment of bipolar disorder.
[MEDLINE abstract]

Fogelson DL, Sternbach H
Journal of Clinical Psychiatry, 1997, 58, 271-273.
Lamotrigine in treatment of refractory bipolar disorder.
[No MEDLINE abstract available]

Frye MA, Ketter TA Dunn RT et al.
Journal of Clinical Psychopharmacology, 2000, 20, 607-614.
A placebo-controlled study of lamotrigine and gabapentin monotherapy in refractory mood disorders.
[MEDLINE abstract]

Gareri P, Falconi U, De Fazio P, De Sarro G.
Progress in Neurobiology, 2000, 61, 353-396.

Conventional and new antidepressant drugs in the elderly.

[MEDLINE abstract]

Gelenberg AJ
Biological Therapies in Psychiatry Newsletter, 1997, 20, 21-24.
New anticonvulsants in bipolar and other psychiatric disorders.

Ghaemi SN, Gaughan S
Harvard Review of Psychiatry, 2000, 8, 1-7.
Novel anticonvulsants: A new generation of mood stabilizers?
[MEDLINE abstract]

Gilmer WS.
Expert Opinion in Pharmacotherapy, 2001, 2, 1597-1608.
Anticonvulsants in the treatment of mood disorders: Assessing current and future roles.
[MERDLINE abstract

Gitlin MJ. Bulletin of the Menninger Clinic 2001, 65, 26-40.
Treatment-resistant bipolar disorder.
[MEDLINE abstract]

Goldberg JF, Burdick KE.
Journal of Clinical Psychiatry, 2001, 62 (Suppl 14), 27-33.
Cognitive side effects of anticonvulsants.
[MEDLINE abstract]

Goodnick PJ, Chaudhry TA, Barrios C.
Expert Opinion in Pharmacotherapy, 2001, 2, 1963-1673.
Rapid cycling bipolar disorder.
[MEDLINE abstract]

Goodwin GM, Bowden CL, Calabrese JR, et al.
Journsal of Clinical Psychiatry, 2004, 65, 432-441.

A pooled analysis of 2 placebo-controlled 18-month trials of lamotrigine and lithium maintenance in bipolar I disorder.
[MEDLINE abstract]

Grof P.
J Clin Psychiatry. 2003;64 Suppl 5:53-61. Review.
Selecting effective long-term treatment for bipolar patients: monotherapy and combinations.
MEDLINE abstract]

Grunze H, Kasper S, Goodwin G, et al.
World Journal of Biological Psychiatry, 2002, 3, 115-124.
World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of bipolar disorders. Part I: Treatment of bipolar depression.
[MEDLINE abstract]

Grunze H, Walden J.
Journal of Affective Disorders, 2002, 72 (Dec), S15-S21.
Relevance of new and newly rediscovered anticonvulsants for atypical forms of bipolar disorder.
[MEDLINE abstract]

Hageman I, Andersen HS, Jorgensen MB. Related Articles
Acta Psychiatrica Scandinavica 2001 Dec;104(6):411-422.
Post-traumatic stress disorder: a review of psychobiology and pharmacotherapy.
[MEDLINE abstract]

Hamer RM & Simpson PM
Biological Psychiatry, 1999, 46, 1711-1712.
The efficacy of lamotrigine in rapid cycling and non-rapid cycling patients with bipolar disorder.
[MEDLINE abstract]

Hertzberg MA, Butterfield MI, Feldman ME, et al.
Biological Psychiatry, 1999, 45, 1226-1229.
A preliminary study of lamotrigine for the treatment of posttraumatic stress disorder.
[MEDLINE abstract]

Hosak L, Libiger J.
European Psychiatry, 2002, 17, 371-378.
Antiepileptic drugs in schizophrenia: a review.
[MEDLINE abstract]

Hurley SC.
Annals of Pharmacotherapy, 2002, 36, 860-873.
Lamotrigine update and its use in mood disorders.
[MEDLINE abstract]

Ichim L, Berk M, Brook S
Annals of Clinical Psychiatry, 2000, 12, 5-10.
Lamotrigine compared with lithium in mania: A double blind randomized controlled trial.
[MEDLINE abstract]

Kaufman KR
Annals of Clinical Psychiatry, 1998, 10, :181-184.
Adjunctive tiagabine treatment of psychiatric disorders: three cases.
[MEDLINE abstract]

Kaufman KR & Gerner R
Seizure 1998 7, 163-165.
Lamotrigine toxicity secondary to sertraline.
[MEDLINE abstract]

Keck PE Jr, McElroy SL.
Journal of Clinical Psychiatry, 2003, 64 (Suppl 1), 13-18.
New approaches in managing bipolar depression.
[MEDLINE abstract]

Keck PE Jr, McElroy SL, Strakowski SM
Journal of Clinical Psychiatry 1998, 59 (Suppl 6),74-81.
Anticonvulsants and antipsychotics in the treatment of bipolar disorder.
[MEDLINE abstract]

Keck PE, Mendlwicz J, Calabrese JR, Fawcett J, Suppes T, Vestergaard PA, Carbonell C.
Journal of Affective Disorders 2000, 59 (Suppl 1), S31-S37.
A review of randomized, controlled clinical trials in acute mania.
[MEDLINE abstract]

Koek RJ & Yerevanian BI
Pharmacopsychiatry 1998, 31, 35.
Is lamotrigine effective for treatment-refractory mania?
[No MEDLINE abstract available]

Kossen M, Selten JP, Kahn RS.
American Journal of Psychiatry 2001 Nov;158(11):1930.
Elevated clozapine plasma level with lamotrigine.
[No MEDLINE abstract available]

Kotler M & Matar MA
Clinical Neuropharmacology 1998, 21, 65-67.
Lamotrigine in the treatment of resistant bipolar disorder.
[MEDLINE abstract]

Kusumakar V, Yatham LN
American Journal of Psychiatry 1997, 154, 1171-1172.
Lamotrigine treatment of rapidly cycling bipolar disorder.
[No MEDLINE abstract available]

Kusumakar V, Yatham LN
Psychiatry Research 1997, 19, 145-148.
An open study of lamotrigine in refractory bipolar depression.
[MEDLINE abstract]

Labbate LA & Rubey RN
American Journal of Psychiatry, 1997, 154, 1317.
Lamotrigine for treatment-refractory bipolar disorder.
[No MEDLINE abstract available]

Li X, Ketter TA, Frye MA Journal of Affective Disorders, 2002, 69, 1-14.
Synaptic, intracellular, and neuroprotective mechanisms of anticonvulsants: are they relevant for the treatment and course of bipolar disorders? [MEDLINE abstract]

Lovell RW
American Journal of Psychiatry, 1999, 156, 980-981.
Mood stabilizer combinations for bipolar disorder.
[No MEDLINE abstract available]

Macdonald KJ, Young LT.
CNS Drugs, 2002, 16, 549-562.
Newer antiepileptic drugs in bipolar disorder: rationale for use and role in therapy.
[MEDLINE abstract]

Maidment ID
Annals of Pharmacotherapy, 1999, 33, 864-867.
Lamotrigine---An effective mood stabilizer?
[MEDLINE abstract]

Malhi GS, Mitchell PB, Salim S.
CNS Drugs. 2003;17(1):9-25.
Bipolar depression: management options.
[MEDLINE abstract]

Maltese TM
American Journal of Psychiatry, 1999, 156, 1833.
Adjunctive lamotrigine treatment for major depression.
[No MEDLINE abstract available]

Margolese HC, Beauclair L, Szkrumelak N, at al.
American Journal of Psychiatry, 2003, 160, 183-184.
Hypomania induced by adjunctive lamotrigine.
[No MEDLINE abstract available]

Martin R, Kuzniecky R, Ho S, et al.
Neurology, 1999, 15, 321-327.
Cognitive side effects of topiramate, gabapentin, and lamotrigine in healthy young adults.
[MEDLINE abstract]

Meador KJ, Loring DW, Ray PG, et al.
Neurology, 2001, 56, 1177-1182.
Differential cognitive and behavioral effects of carbamazepine and lamotrigine. [MEDLINE abstract]

Mitchell PB, Malhi GS.
Annual Review of Medicine, 2002, 53, 173-188.

The expanding pharmacopoeia for bipolar disorder.

[MEDLINE abstract]

Normann C, Hummel B, Scharer LO, Horn M, Grunze H, Walden J.
Journal of Clinical Psychiatry, 2002, 63, 337-344.
Lamotrigine as adjunct to paroxetine in acute [unipolar]depression: A placebo-controlled, double-blind study.
[MEDLINE abstract]

Obrocea GV, Dunn RM, Frye MA, Ketter TA, Luckenbaugh DA, Leverich GS, Speer AM, Osuch EA, Jajodia K, Post RM.
Biological Psychiatry. 2002, 51, 253-260.
Clinical predictors of response to lamotrigine and gabapentin monotherapy in refractory affective disorders.
[MEDLINE abstract]

Passmore MJ, Garnham J, Duffy A, MacDougall M, Munro A, Slaney C, Teehan A, Alda
Bipolar Disorders, 5, 110-114.
Phenotypic spectra of bipolar disorder in responders to lithium versus lamotrigine.
[MEDLINE abstract]

Pies R.
Annals of Clinical Psychiatry, 2002, 14, 223-232.
Combining lithium and anticonvulsants in bipolar disorder: a review. [MEDLINE abstract]

Pinto OC & Akiskal HS
Journal of Affective Disorders, 1998, 51, 333-343.
Lamotrigine as a promising approach to borderline personality: An open case series without concurrent DSM-IV major mood disorder.
[MEDLINE abstract]

Post RM
Schizophrenia Research, 1999, 39, 153-158.
Comparative pharmacology of bipolar disorder and schizophrenia.
[MEDLINE abstract]

Post RM, Denicoff KD, Frye MA, Dunn RT, Leverich GS, Osuch E, Speer A
Neuropsychobiology, 1998, 38, 152-166.
A history of the use of anticonvulsants as mood stabilizers in the last two decades of the 20th century.
[MEDLINE abstract]

Post RM, Frye MA, Denicoff KD, et al.
Bipolar Disorders, 2000, 2, :305-315.
Emerging trends in the treatment of rapid cycling bipolar disorder: a selected review.
[MEDLINE abstract]

Post RM, Frye MA, Denicoff KD, et al.
Neuropsychopharmacology 1998, 19, 206-219.
Beyond lithium in the treatment of bipolar illness.
[MEDLINE abstract]

Post RM, Leverich GS, Denicoff KD, et al.
Depression and Anxiety, 1997, 5, 275-189.
Alternative approaches to refractory depression in bipolar illness.
[MEDLINE abstract]

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[MEDLINE Abstract]

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31. Additions and corrections?

Please address additions and corrections to:

Ivan K. Goldberg, M.D.
1556 Third Avenue
New York, NY 10128-3100

Voice: +1 212 876 7800
Fax: +1 212-876-7821

Email Psydoc@PsyCom.Net

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Revised 4 April 2011