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Lamotrigine Is Not Slow James Phelps, MD Director Mood Disorders Program Samaritan Mental Health, Corvallis, OR.

How Slow Is Lamotrigine? Change from baseline to each treatment visit in Mean MADRS Total Score (with 95% confidence interval bars) Less effective Brown, E. B., McElroy, S. L., Keck Jr, P. E., Deldar, A., Adams, D. H., Tohen, M., & Williamson, D. J. (2006). A 7-week, randomized, double-blind trial of olanzapine/fluoxetine combination versus lamotrigine in the treatment of bipolar I depression. The Journal of clinical psychiatry, 67(7), 1025-1033. 

If not immediately dangerous Consider lamotrigine Bipolar depression ECT Quetiapine Robust evidence OFC If not immediately dangerous Consider lamotrigine Phelps, J. R. (2016). A spectrum approach to mood disorders: not fully bipolar but not unipolar: practical management. New York: W. W. Norton & Company.

Key Points Lamotrigine is not much slower than antidepressants to produce benefits If the patient has dangerously severe symptoms, other treatmetns like ECT and olanzapine are much faster Patients tend to choose medication based on tolerability, not speed

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