When do you consider lamotrigine in bipolar depression?  

Lamotrigine can be initiated and maintained in bipolar II since hypomanic episodes would be unusual. As mentioned before, it is not for an acute situation but can be introduced anytime. Dosing though is recommended as no less than 200 mg and can be taken to above 400 mg. Please check levels 8 to 12....

Usually for maintenance treatment of bipolar depression, given its lengthy titration schedule. Patients may need a dose of 100-400 mg to control their BD. Depends if it's monotherapy or adjuvant. For an acute episode, it's better to use "faster" options like quetiapine, lurasidone, cariprazine, or ...

Lamotrigine is usually not the first choice in acute psychiatric states due to the slow titration required (to prevent Stevens-Johnson syndrome risk). It's not ideal as sole therapy for acute situations, especially given interactions with Valproic acid. Alternative medications should be maintained u...

Lithium carbonate is the "gold standard" for treatment of bipolar disorder. I will prescribe lamotrigine only after the patient has tried and failed lithium.

Lithium has a range of side effects that not everyone tolerates well. I typically start with an atypical antipsychotic or Depakote for bipolar disorder type I (BMD I). If these options fail a couple of times, I'll consider lithium. However, it can cause tremors, acne, a metallic taste, and swelling,...

As noted, lamotrigine is used to prevent future depressive episodes. So its use is most often started when there is a period of relative stability. It appears helpful in these circumstances if dosage recommendations are followed and precautions are taken regarding rash. I would consider lamotrigine...