What is the best antidepressant to take with Lamictal? (3 options)
By
Ivan Kahwa
| Reviewed by
Ivan Kahwa
The contents of this article are fact-based except otherwise stated within the article.
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Author bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
Reviewer bio
Mr Ivan Kahwa is a chemist and phytopharmaceutical scientist with expertise in chemistry, pharmacology, phytochemistry, and Nanobiotechnology. He writes and reviews content on these topics.
Mr Ivan Kahwa’s Highlights:
Guest Researcher at the University of Leipzig, Senior Research Fellow/Scientist, and Lecturer at the Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology.
Professional Experience:
Mr Ivan joined PHARMBIOTRAC as a research fellow/scientist during his master of science tenure. He contributed to the development of most of the phytopharmaceutical products in the project. Furthermore, he participated in carrying out the pharmacological activities of the developed products in laboratory animals such as mice and rats in order to develop proper doses hence leading to pre-clinical studies.
With the above relevant research experience, Ivan started to work with the University of Leipzig on collaborative projects with Mbarara University to develop the chemistry of Ugandan Medicinal plants and their pharmacological activities. This was coupled with several consultative positions by different German NGOs. Mr. Kahwa is also a supporting in the teaching and learning at the Departments of Pharmacy and Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology.
With the increase in antimicrobial resistance globally, Ivan retooled his thinking towards developing new naturally derived antibiotic regimens from Ugandan propolis with the assistance of nanotechnology to improve their delivery to microbial cells. Kahwa has also published over 28 articles in peer-reviewed journals and he is currently reviewing for many journals.
Education:
2023-2027: PhD in Pharmaceutical Sciences (ongoing) with a focus on Pharmaceutical Microbiology and Nanobiology at Mbarara University of Science and Technology.
2022: 2Msc. in Pharmacognosy and Natural Medicine Science at Mbarara University of Science and Technology.
2018: Bachelor of Science (Chemistry) at Mbarara University of Science and Technology.
Publications:
▪ Iqbal, S., Jabeen, F., Kahwa, I., & Omara, T. 2023. Suberosin Alleviates Thiazolidinedione-Induced Cardiomyopathy in Diabetic Rats by Inhibiting Ferroptosis via Modulation of ACSL4-LPCAT3 and PI3K-AKT Signaling Pathways. Cardiovascular Toxicology. https://doi.org/10.1007/s12012-023-09804-7
▪ Gupta, A. K., Yadav, R., Sharma, S., Sawale, J., & Kahwa, I. 2023. Anti-ageing Activity and Antioxidant Activity of Methanol Extracts of Leaves and Flowers of Salvia officinalis and Rosmarinus officinalis. Journal of Young Pharmacists, 15(3), 448–455. https://doi.org/10.5530/jyp.2023.15.60
▪ Tolo, C.U., Kahwa, I., Nuwagira, U., Weisheit, A. and Ikiriza, H., 2023. Medicinal plants used in treatment of various diseases in the Rwenzori Region, Western Uganda. Ethnobotany Research and Applications, 25, pp.1-16.
https://ethnobotanyjournal.org/index.php/era/article/view/4683
▪ Kahwa, I., Ajayi, C.O., Yadav, R., Chauhan, N.S., Shah, K., Abdelgadir, A.A., Shegena, E.A., Daniel, S., Omara, T., Asiimwe, J.B. and Ikiriza, H., 2023. Pharmacognostic and phytochemical studies as an invaluable approach for correct identification of medicinal plants: The case of Artemisia vulgaris L. substituted for Artemisia annua L. in Western Uganda. TMR Integr Med, 7, p.e23004.
https://doi.org/10.53388/TMRIM202307004
▪ Nalimu, F., Oloro, J., Kahwa, I. and Ogwang, P.E., 2021. Review on the phytochemistry and toxicological profiles of Aloe vera and Aloe ferox. Future Journal of Pharmaceutical Sciences, 7, pp.1-21.
https://doi.org/10.1186/s43094-021-00296-2
▪ Elamin, O.H.S., Ali, M.A., Elgezuli, I.A.A., Bashir, M.A. and Kahwa, I., 2021. Diagnosis of pre-and post-treatment of echinococcus granulosus with counter current immune electrophoresis and bacterial co-agglutination. Journal of Microbiology and Infectious Diseases, 11(02), pp.88-94.
https://doi.org/10.5799/jmid.951600
Published book Chapter
▪ Kahwa, I., Ayesiga, I., Nakalema, S., Alinaiswe, R., Mbabazi, R. and Iqbal, S., 2023. Natural products in the management of onchocerciasis. In Natural Products in Vector-Borne Disease Management (pp. 63-80). Academic Press. Book Chapter.
https://doi.org/10.1016/B978-0-323-91942-5.00012-4
Submitted manuscripts Under Review:
▪ Comparison of the Wound Healing Activity of the Leaf and Leaf Ash Extracts of Vernonia amygdalina in Rats. Journal name: Clinical Phytoscience
▪ Ethnobotanical Survey of Medicinal plants used in the management of cancer in Uganda. Journal name: Journal of Herbal Medicine
▪ Ethnobotanical survey and phytochemical screening of medicinal plants used in treatment of epilepsy by PROMETRA-Uganda Traditional Health Practitioners in Mpigi District, Uganda. Journal name: Journal of Ethnopharmacology
Submitted book chapters under review
1.Book title: Algae as a Natural Solution for Water-Food-Energy Nexus, Section 4: Microalgae and cyanobacteria for food applications, Chapter 4.6: Safety, toxicological and allergenic aspects of using algae for food. Authors: Christine Kyarimpa, Tom Omute, Caroline K. Nakiguli, Alice V. Khanakwa4, Christopher Angiro, Ivan Kahwa, Fortunate Ahumuza, Timothy Omara*. Publisher: Springer Nature Singapore Pte Ltd. 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore.
2.Book title: Nutraceuticals Inspiring the Contemporary Therapy for Lifestyle Diseases. Chapter: Nutraceutical applications of Seaweeds and their Phytocompounds in Nutrition and Treatment of Diseases. Authors: Ivan Kahwa, Timothy Omara , Innocent Ayesiga , Gael Noel Neh Neba Ambe , Zehbanaz Javidbhai Panwala , Rachel Mbabazi , Shabnoor Iqbal , Christine Kyarimpa , Christine Betty Nagawa , Kamal Shah ,Nagendra Singh Chauhan* Publisher: CRC Press
You can view my works on the following professional sites:
Research Gate: https://www.researchgate.net/profile/Ivan-Kahwa
Google Scholar: https://scholar.google.com/citations?user=tOwrvqoAAAAJ&hl=en
ORCID: https://orcid.org/0000-0002-6440-3437
Linkedin: https://de.linkedin.com/in/ivan-kahwa-865450159
In this article, we will discuss the best antidepressants to take with Lamictal. We will also discuss some research studies and what one should do to ensure the safe and effective use of Lamictal with antidepressants.
What is the best antidepressant to take with Lamictal?
The best antidepressants to take for Lamictal include:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Atypical antidepressants
Selective serotonin reuptake inhibitors (SSRIs)
Lamictal (lamotrigine) can be paired with SSRIs, the most commonly prescribed antidepressants. SSRIs are usually considered the first-line drugs for depression and anxiety (1).
Taking them with Lamictal can offer potential health benefits, especially for people with major depressive disorder (MDD) or psychosis comorbid with depression, as Lamictal can be used as a mood stabiliser, such as the combination of Lamictal and Prozac.
SSRIs typically include: (1)
- Fluoxetine (Prozac)
- Escitalopram (Lexapro)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
- Fluvoxamine (Luvox)
However, it is important to note that these medications could have potential interactions that might not be concerning for some individuals but can affect others. So, such combinations should be carefully prescribed.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SNRIs can also be taken with Lamictal. These medications work on both serotonin and norepinephrine levels and can help address symptoms of anxiety and depression more broadly. (2)
When combined with Lamictal, these medications can actively manage symptoms of affective mood disorders. SNRIs typically include: (2)
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor)
- Desvenlafaxine (Pristiq)
However, it is important to note that not everyone taking such combinations will respond well to them. Individuals are different and can respond differently to such medications. So, make sure you only pair Lamictal with SNRIs when prescribed by your provider.
Atypical antidepressants
Atypical antidepressants can also be taken with Lamictal, and there are no apparent drug interactions associated with them. Atypical antidepressants include: (3)
- Bupropion (Wellbutrin)
- Mirtazapine (Remeron)
- Vilazodone (Viibryd)
- Vortioxetine (Trintellix)
Atypical antidepressants do not work like SSRIs or SNRIs, which are considered typical antidepressants. These meds have a distinct mechanism of action and can affect dopamine levels as well.
This can offer potential mental health benefits in some cases, and together with Lamictal, these medications can manage broader symptoms of mood or personality disorders.
Taking Lamictal can also lower the potential for Wellbutrin to cause seizures in susceptible individuals. However, it is important to ensure you do not combine any such medication without consulting your doctor first.
What does research suggest?
Research studies have shown that Lamotrigine (Lamictal) augmentation in antidepressant treatment can offer potential benefits. One research study indicated that combining Lamotrigine with a suitable SSRI can help manage unipolar depression more effectively (4).
The study also indicated that pairing Lamictal with an SSRI is more effective than pairing it with an SNRI (4). However, studies have also shown that the combined use of Lamotrigine and venlafaxine can actively manage bipolar 2 disorder in adolescents. (5)
Research also shows that Lamictal itself has antidepressant effects and can manage unipolar and bipolar disorder when taken alone (6). Lamotrigine is not typically known to interact with antidepressants, but some research studies do show a link.
An old research article stated that taking sertraline with Lamictal can increase the concentration of Lamictal dangerously in the body and can cause side effects, thereby increasing the chances of Lamictal toxicity (7). However, a more recent study couldn’t find an interaction between sertraline and Lamotrigine. (8)
What are the risks of taking Lamictal with antidepressants?
The potential risks of taking Lamictal with antidepressants include:
Additive side effects
Combining Lamictal with antidepressants may lead to additive side effects. These can include:
- Dizziness: Both Lamictal and certain antidepressants may cause dizziness, especially upon standing. Combining them could intensify this side effect.
- Drowsiness: Sedative effects may be heightened when Lamictal is used in conjunction with specific antidepressants, potentially increasing daytime drowsiness.
- Nausea: The likelihood of experiencing nausea may increase when antidepressants and Lamictal are taken together.
- Headache: Headache is a common side effect of both Lamictal and some antidepressants, and their combination could exacerbate this issue.
Pharmacokinetic interactions
There is a potential for pharmacokinetic interactions between Lamictal and antidepressants. This refers to how the body absorbs, distributes, metabolizes, and eliminates drugs. Some antidepressants may affect the metabolism of Lamictal, leading to changes in its blood levels.
Serotonin syndrome risk
Certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can elevate serotonin levels.
When combined with Lamictal, there may be an increased risk of serotonin syndrome – a potentially serious condition characterized by symptoms such as agitation, hallucinations, rapid heartbeat, fever, muscle stiffness, and coordination issues. (9)
Does Lamictal need dosage adjustment when combined with antidepressants?
Lamictal may or may not need dose adjustments. Some people may do well on standard doses, while others may require dose reduction of either the antidepressant or Lamictal. It depends on the individual taking the drug and additional factors that might be affecting their health.
So, make sure you do not take these medications until prescribed by your healthcare provider. The typical dosage recommendations for Lamictal include: (10)
| Condition | Age groups | Initial Dose | Maintenance Dose Range | Titration Schedule |
| Bipolar Disorder | Adults | 25 mg once daily for 2 weeks | 50 to 200 mg per day | Increase by 25 to 50 mg every 1 to 2 weeks as needed |
| Children | 25 mg every other day for 2 weeks | 1 to 5 mg/kg per day | Increase by 25 to 50 mg every 1 to 2 weeks as needed | |
| Epilepsy | Adults | 25 mg once daily for 2 weeks | 100 to 200 mg per day | Increase by 25 to 50 mg every 1 to 2 weeks as needed |
| Children | Based on weight and age | Varies | Dose should be determined based on age and body weight |
The above-mentioned dosage recommendations can vary among individuals. Make sure you do not exceed the doctor’s recommended dose or take Lamictal more often than prescribed.
How to ensure the safe use of Lamictal with antidepressants?
The following points are important to ensure the safe and effective use of Lamictal with antidepressants.
- Always consult with your healthcare provider before combining Lamictal with antidepressants.
- Provide a thorough medical history, including any previous experiences with seizures, mental health conditions, or adverse reactions to medications.
- Follow your healthcare provider’s prescribed dosage for both Lamictal and the antidepressant. Avoid self-adjusting doses, as this can lead to unpredictable interactions and side effects.
- Be aware of the potential side effects associated with Lamictal and the specific antidepressant you are taking. Report any unusual symptoms promptly to your healthcare provider.
- Understand the symptoms of serotonin syndrome, such as agitation, hallucinations, rapid heartbeat, and muscle stiffness. Seek immediate medical attention if these symptoms occur.
- Minimize or avoid alcohol and recreational drug use, as they can interact with both Lamictal and antidepressants, potentially leading to adverse effects.
As a pharmacist, I always help my patients understand the importance of safe drug use. People who are on a combination of medications that can affect their brain chemistry, such as Lamictal and antidepressants, should keep a close eye on their side effects and discuss any concerns with their provider.
References
- Chu A, Wadhwa R. Selective Serotonin Reuptake Inhibitors. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 32119293. https://www.ncbi.nlm.nih.gov/books/NBK554406
- Sansone RA, Sansone LA. Serotonin norepinephrine reuptake inhibitors: a pharmacological comparison. Innov Clin Neurosci. 2014 Mar;11(3-4):37-42. PMID: 24800132; PMCID: PMC4008300. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008300/
- Maj J. Atypical antidepressant drugs – psychopharmacological profile and mechanism of action. Pharmacopsychiatria. 1982 Jan;15(1):26-30. doi: 10.1055/s-2007-1019505. PMID: 7199735. https://pubmed.ncbi.nlm.nih.gov/7199735/
- Goh KK, Chen CH, Chiu YH, Lu ML. Lamotrigine augmentation in treatment-resistant unipolar depression: A comprehensive meta-analysis of efficacy and safety. J Psychopharmacol. 2019 Jun;33(6):700-713. doi: 10.1177/0269881119844199. Epub 2019 May 13. PMID: 31081449. https://pubmed.ncbi.nlm.nih.gov/31081449/
- Bildik T, Tamar M, Korkmaz S, Gokcen S, Ozbaran B, Erermis S, Aydin C. Lamotrigine add-on therapy to venlafaxine treatment in adolescent-onset bipolar II disorder: a case report covering an 8-month observation period. Int J Clin Pharmacol Ther. 2006 May;44(5):198-206. doi: 10.5414/cpp44198. PMID: 16724574. https://pubmed.ncbi.nlm.nih.gov/16724574/
- Solmi M, Veronese N, Zaninotto L, van der Loos ML, Gao K, Schaffer A, Reis C, Normann C, Anghelescu IG, Correll CU. Lamotrigine compared to placebo and other agents with antidepressant activity in patients with unipolar and bipolar depression: a comprehensive meta-analysis of efficacy and safety outcomes in short-term trials. CNS Spectr. 2016 Oct;21(5):403-418. doi: 10.1017/S1092852916000523. PMID: 27686028. https://pubmed.ncbi.nlm.nih.gov/27686028/
- Kaufman KR, Gerner R. Lamotrigine toxicity secondary to sertraline. Seizure. 1998 Apr;7(2):163-5. doi: 10.1016/s1059-1311(98)80074-5. PMID: 9627209. https://pubmed.ncbi.nlm.nih.gov/9627209/
- Christensen J, Sandgaard AP, Sidenius P, Linnet K, Licht RW. Lack of interaction between sertraline and lamotrigine in psychiatric patients: a retrospective study. Pharmacopsychiatry. 2012 May;45(3):119-21. doi: 10.1055/s-0031-1297975. Epub 2012 Mar 16. PMID: 22426846. https://pubmed.ncbi.nlm.nih.gov/22426846/
- Simon LV, Keenaghan M. Serotonin Syndrome. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29493999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482377
- Betchel NT, Fariba KA, Saadabadi A. Lamotrigine. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262021. https://www.ncbi.nlm.nih.gov/books/NBK470442