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

3. 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),  

4. 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.

5. 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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