What is the best antidepressant to take with Lamictal? (3 options)

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)

ConditionAge groups Initial DoseMaintenance Dose RangeTitration Schedule
Bipolar Disorder Adults 25 mg once daily for 2 weeks50 to 200 mg per dayIncrease by 25 to 50 mg every 1 to 2 weeks as needed
Children 25 mg every other day for 2 weeks1 to 5 mg/kg per dayIncrease by 25 to 50 mg every 1 to 2 weeks as needed
EpilepsyAdults 25 mg once daily for 2 weeks100 to 200 mg per dayIncrease by 25 to 50 mg every 1 to 2 weeks as needed
Children Based on weight and ageVariesDose 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.


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