At the time of this writing, lamotrigine as a sole agent hasn’t been mentioned in any studies as beeingan an effective DPDR remedy. However, evidence from open trials suggest it may be beneficial as an “add-on” medication with anti-depressants like SSRIs
During my DPDR recovery I did not take any pharmaceuticals, neither am I a doctor, nevertheless one of the first questions I had during my DPDR was “is there a pill that can cure me?”. Therefor, I contacted a pharmacist to write this article for me.
Keep on reading to gain insights into Lamotrigine and its effects on DPDR.
Lamotrigine
Lamotrigine, an anticonvulsant and mood stabilizer used to treat epilepsy and bipolar disorder, along with experimental uses for schizophrenia, depression, and borderline personality disorder.
Lamotrigine comes under the brand name Lamictal.
Lamotrigine belongs to a class of drugs called anticonvulsants or antiepileptic drugs (AEDs). It is used to treat seizures and bipolar disorders.
For people with epilepsy, this drug reduces the release of a substance in your brain known as glutamate. This action prevents the neurons in your brain from becoming too active. As a result, you may have fewer seizures.
For people with bipolar disorder, this drug may affect certain receptors in your brain that help control your mood.
With this condition, a person has extreme emotional highs and lows. This could decrease the number of mood episodes you have.
Lamotrigine acts at the presynaptic membrane to reduce the release of glutamate (excitory neurotransmitter), and it has been shown to reverse depersonalization-related phenomena induced by the N-methyl-D-aspartate (NMDA) receptor antagonist ketamine in healthy individuals (Anand et al, 2000).
A different body of research suggests that glutamate might be relevant to dissociation. Sub-anesthetic doses of the N-methyl D-aspartate receptor antagonist ketamine were shown to induce subjective experiences characteristic of depersonalization.
It is believed that the altered state of consciousness induced by ketamine is mediated by increased glutamate release in response to NMDA receptor blockades, with a consequent excess of glutamate activity at non-NMDA glutamate receptors.
Lamotrigine has been reported in the treatment of DPDR because of its ability to impede glutamate release at the presynaptic membrane and to reduce the effects of ketamine on consciousness (Anand et al. 2000; Wang et al. 1996).
Neither lamotrigine alone nor serotonergic antidepressants alone have been shown to be reliably effective in treating depersonalization disorder, but study suggests that when used in combination, these medications can produce a profound reduction in symptoms.
Dosage:
- Initial: 50 mg PO qDay for 2 weeks, THEN
- 100 mg/day divided q12hr for 2 weeks
Side effects of Lamotrgine
Lamotrigine oral tablet may cause drowsiness. Do not drive, use heavy machinery, or do other dangerous activities until you know how this drug affects you.
The more common side effects that can occur with use of lamotrigine include:
• dizziness
• drowsiness
• headache
• double vision
• blurred vision
• nausea and vomiting
• diarrhea
Case Study
Case series of 32 patients with depersonalization disorder who had been treated with lamotrigine, most of them were previously taking an antidepressant medication (SSRIs, SNRIs, or tricyclic antidepressants). 56% of patients overall showed a response of a 30% or greater reduction in their symptoms on CDS score during treatment with lamotrigine, which lasted for an average of 13.7 months.
Of those patients taking lamotrigine in combination with an SSRI, 81.8% achieved a reduction of 30% or more in their symptoms on CDS score.
Lamotrigine should be initiated at a starting dose of 25 mg/day, with the dose gradually increased at fortnightly intervals, and a greater lamotrigine dose was significantly correlated with a greater decrease in CDS score.
Conclusion
Lamotrigine as sole agent was not found to be effective in the discussed randomized trial. However, evidence from open trials suggest it may be beneficial as an “add-on” medication with anti-depressants like SSRIs. Lamotrigine is prescribed as an augmenting medication.
Lamotrigine in combination with SSRIs is also one of the very few approaches that has shown some efficacy in treating chronic depersonalization, the syndrome of unremitting depersonalization and derealization symptoms that can last for decades. Depersonalization disorder is highly distressing to sufferers and associated with a wide array of negative mental health and social outcome