WHY DO I PRESCRIBE LAMICTAL (LAMOTRIGINE) ?

Recently my business manager noticed that a question was raised about my prescribing Lamictal [lamotrigine] for a 9 year old girl.  I realized then that I needed to clarify why I made this choice.  I have blogged about it in the past but I felt that I needed to write about it again.

Lamotrigine was introduced as an anticonvulsant [antiseizure] medication and received negative publicity after some people who were taking it developed a very serious rash that led to a Stephens Johnson reaction resulting in the death of a few people.  It was prescribed for people with very serious and dangerous seizures and as is typical for this type of problem, the dose was maximized in a couple of days.  These people were also taking valproic acid [also an anticonvulsant] and this medication more than doubled the serum level of the Lamictal that had just been rapidly increased leading to extremely high serum levels and the serious rash.  It had also been noted that Lamictal seemed to be very effective in stabilizing moods.  The FDA [Federal Drug Administration] only allowed Lamictal to be used for moods after very extensive testing on thousands of people with the development of a titration protocol that insured that it would be tolerated without a serious rash.  It has since been prescribed and found to be safe and effective.  It is prescribed for mood swings after they have been partially stabilized and is helpful in preventing the swing into depression that plagues people with mood swings about 80% of the time.  

I began noticing that people who had been struggling with the impact of untreated attention deficit hyperactivity disorder [ADHD] were often irritable and reacted to minor situations with frustration.  This frequently continued even after their concentration and attention was improved with medication.  Then someone that I was treating who was experiencing the irritability and reactivity was prescribed Lamictal for headaches and the irritability and reactivity were significantly reduced and were elimiinated with a further titration of the dose of Lamictal.  I then began prescribing Lamictal and found it to be effective in treating the irritability and reactivity.  I would suggest that the Lamictal be continued for a year and then discontinued and there would be no return of those symptoms. I have also found that if I slowly increase the dose, Lamictal is tolerated well. Occasionally someone will develop a small rash on their arm or face and this seems related to the body adjusting to the medication and is not an allergic response.  I will reduce the dose and have a slower increase in dose and the rash goes away and does not reappear.  [The brain's need to adjust to the presence of the medication and then the absence of it is a topic for another blog].

To summarize, I have found that Lamictal is a safe and effective medication to help reduce the irritability and reactivity that can occur because of the stress of untreated ADHD.  I have wondered if these symptoms are related to the brain's attempt to reduce the demands for concentration and focusing by causing people to remove themselves from interacting with others because of the irritability and reactivity that they experience when interacting with others.  It seems to me that interacting with people requires a considerable amount of focusing and attention. What do you think?