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Lamictal vs Depakote
Introduction
For patients with epilepsy or bipolar disorder, certain medications can help control seizures and stabilize mood swings by altering the levels of specific neurotransmitters in the brain. Lamictal and Depakote are two such drugs often prescribed for these conditions. Both work to restore the balance of electrical activity in the brain, but they do so via different mechanisms.
Lamictal (lamotrigine) is classified as an antiepileptic drug that delays electrical signals in the brain responsible for generating seizures. It's also used to delay mood episodes in adults with bipolar disorder.
On the other hand, Depakote (divalproex sodium) belongs to a class of drugs known as anticonvulsants or mood stabilizers. It works by increasing concentrations of gamma-aminobutyric acid (GABA), a calming neurotransmitter that inhibits nerve impulses associated with seizures and mood disorders.
Lamictal vs Depakote Side By Side
| Attribute | Lamictal | Depakote |
|---|---|---|
| Brand Name | Lamictal | Depakote |
| Contraindications | Should not be taken with or have recently stopped using monoamine oxidase inhibitors (MAOIs). | Should not be taken with or have recently stopped using monoamine oxidase inhibitors (MAOIs). |
| Cost | Brand name: around $700 for 60 tablets of 100 mg. Generic: as low as around $8 for 30 x 100mg tablets. | Brand name: approximately $270 for 30 tablets of 500mg. Generic: starts from roughly $15 for 30 capsules/tablets at 500 mg. |
| Generic Name | Lamotrigine | Divalproex Sodium |
| Most Serious Side Effect | Severe skin reactions, including life-threatening rashes. | Liver damage and birth defects if taken during pregnancy. |
| Severe Drug Interactions | Increased risk of suicidal thoughts or behaviors; potential for serious skin reactions. | Increased suicidal thoughts or behaviors; potential for serious liver damage. |
| Typical Dose | 25 mg/day, gradually increasing to a maintenance dose of 100–200 mg/day for bipolar disorder; up to 400 mg/day maximum. | 250 mg twice daily or 500 mg once daily, up to a maximum of 60mg/kg/day. |
What is Lamictal?
Lamotrigine (the generic name for Lamictal) is a mood stabilizer and anticonvulsant, which marked a significant advancement from the earlier class of antiepileptic drugs known as valproic acid derivatives. Lamotrigine was first approved by the FDA in 1994. It works by decreasing abnormal electrical activity in the brain, effectively reducing the frequency of seizures and helping to control wide mood swings in bipolar disorder. It is prescribed for epilepsy treatment as well as bipolar disorder management.
Contrarily, Valproate (known generically as Depakote), another type of mood stabilizer and anticonvulsant that has been around longer than lamotrigine, increases levels of gamma-aminobutyric acid (GABA) in the brain - our natural calming agent - thus slowing down brain activity.
While both medications are effective at treating seizures and managing mood disorders, they differ significantly in their side effect profiles. For example, while Lamictal has fewer side effects overall compared to Depakote; it carries an increased risk of severe rash which can be life-threatening if not managed promptly.
What conditions is Lamictal approved to treat?
Lamictal and Depakote are both approved for the treatment of these conditions:
- Epilepsy: Both are considered first-line treatments for primary generalized tonic-clonic seizures. Lamictal is also used to treat partial seizures.
- Bipolar disorder: Lamictal can be used as a maintenance treatment to delay the time between episodes, while Depakote is often utilized in managing manic episodes.
How does Lamictal help with these illnesses?
Lamictal, also known as lamotrigine, helps to manage epilepsy and bipolar disorder by decreasing excessive electrical activity in the brain. It achieves this by blocking sodium channels on neurons, thus inhibiting the release of glutamate — a type of neurotransmitter responsible for sending signals between nerve cells. By reducing the amount of glutamate released, Lamictal can stabilize abnormal electrical activity in the brain and reduce seizure occurrences or mood swings.
On the other hand, Depakote (or valproic acid) similarly treats seizures and bipolar disorder but operates through a slightly different mechanism. It not only prevents seizures by increasing levels of gamma-aminobutyric acid (GABA), another neurotransmitter that calms neuronal activity in the brain, but it also blocks sodium channels like Lamictal does. Therefore both medications help patients control their conditions—be it epileptic seizures or bouts of mania/depression—but they do so via distinct mechanisms which may have different therapeutic implications depending on individual patient characteristics.
What is Depakote?
Depakote, also known by its generic name divalproex sodium or valproic acid, is a medication primarily used to treat epilepsy and bipolar disorder. Similar to Lamictal (lamotrigine), it works as an anticonvulsant, which means it regulates the abnormal electrical activity in the brain that can lead to seizures. It does this through increasing levels of gamma-aminobutyric acid (GABA) in the brain -- a neurotransmitter that helps send messages between nerve cells.
Depakote was first approved by the FDA in 1983 and has since been used extensively for managing seizure disorders. Unlike lamotrigine, Depakote can also be prescribed for migraine prevention. Its side-effect profile differs somewhat from lamotrigine; common side effects include nausea, drowsiness and weight gain. Importantly however, because of its potential for causing serious liver damage and birth defects if taken during pregnancy, Depakote should only be administered under close medical supervision with appropriate monitoring.
What conditions is Depakote approved to treat?
Depakote is approved for the management of:
- Epilepsy, as it can be used alone or in conjunction with other medications to control certain types of seizures.
- The manic phase of bipolar disorder, helping to stabilize mood and prevent episodes of mania.
- Prevention of migraines. It's important to note that while Depakote helps prevent migraine headaches, it does not relieve a headache once it has started.
How does Depakote help with these illnesses?
Depakote, also known as valproic acid, plays a crucial role in the treatment of bipolar disorder and epilepsy. It operates by increasing the amount of gamma-aminobutyric acid (GABA) in the brain. GABA is an inhibitory neurotransmitter that helps to balance out excitatory neurotransmitters, thus preventing seizures and mood episodes.
Depakote's effect on these neurochemicals can help reduce symptoms such as manic episodes associated with bipolar disorder or decrease seizure frequency in epileptic patients. As it has a broader spectrum of activity compared to Lamictal (lamotrigine), Depakote might be chosen when a patient does not respond adequately to other medications or combined with others for better control over mental health issues or seizure disorders.
How effective are both Lamictal and Depakote?
Both Lamotrigine (Lamictal) and Valproate (Depakote) have established histories of success in managing seizure disorders such as epilepsy, with initial FDA approval only a few years apart. They work on different aspects of neuronal signaling, thus they may be prescribed under distinct circumstances. The effectiveness of Lamotrigine and Valproate in controlling seizures was directly studied in several clinical trials; these two drugs demonstrated comparable efficacy in reducing seizure frequency while also showing promising safety profiles.
A 1997 review highlighted the effectiveness of Lamotrigine starting from the first weeks of treatment, its favorable side effect profile compared to many other antiepileptics, and its good tolerance even among pediatric populations. This study reported that Lamotrigine has become one of the most widely prescribed antiepileptic drugs worldwide due to its broad spectrum activity against various types of seizures.
In contrast, a 2013 meta-analysis indicated that valproate seems to be more effective than placebo for treating generalized onset seizures but is typically considered a secondary treatment option for focal onset seizures. Significant research on its use involves co-prescription alongside another first-line antiepileptic drug so data confirming its efficacy as a stand-alone treatment is less robust than that for lamotrigine. Further evidence supporting valproate significantly augmenting the effect of other anti-epileptics lacks general consensus. Nonetheless, because it acts differently from most other anti-epileptics by increasing GABAergic signalling and modulating voltage-gated sodium channels and T-type calcium channels simultaneously, it may be an optimal choice for patients who did not respond well to other treatments or need additional control over their symptoms.
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At what dose is Lamictal typically prescribed?
Oral dosages of Lamictal start from 25 mg/day, gradually increasing to a maintenance dose that ranges between 100–200 mg/day for treating bipolar disorder in adults. For children and adolescents with epilepsy, the starting dosage can be as low as 0.15 mg/kg/day and may gradually be increased depending on their response. In either population, the dosage can be adjusted after a few weeks if there is no significant improvement observed. The maximum daily dose varies widely based on individual factors but should not exceed 400 mg under any circumstances.
At what dose is Depakote typically prescribed?
Depakote therapy typically begins with a dosage of 250 mg twice daily, or 500 mg once daily. The dose can then be increased to a maximum of 1000 mg per day, divided into two doses taken every 12 hours. If there's no significant improvement in symptoms after several weeks at this dosage, healthcare providers may consider increasing the dosage further, up to an absolute maximum of 60mg/kg/day. This must be done under careful medical supervision as high dosages can lead to potential side effects and risks that need close monitoring.
What are the most common side effects for Lamictal?
Common side effects of Lamictal can include:
- Dizziness
- Headache
- Double vision or blurred vision
- Nausea, vomiting, and diarrhea
- Insomnia
- Fever
- Dry mouth
- Abdominal pain
- Tremor (unintentional trembling or shaking)
- Rash
While common side effects of Depakote may include:
-Nausea and vomiting
-Drowsiness/somnolence (sleepiness/drowsiness)
-Dizziness
-Tremors
-Hair loss
-Increased appetite leading to weight gain
-Decreased libido (sex drive)
-Asthenia (general weakness and fatigue)
These are not exhaustive lists. If you experience any severe reactions such as rash with fever, blistering/peeling skin, suicidal thoughts or actions; seek immediate medical attention.
Are there any potential serious side effects for Lamictal?
While Lamictal and Depakote are both used to treat seizure disorders and bipolar disorder, they come with their own potential risks. For instance:
- Increased thoughts about suicide or self-harm: Both medications may increase the risk of suicidal thoughts or behaviors, particularly in children and young adults.
- Serious skin reactions: Both can cause severe skin reactions, but this is more common with Lamictal. Symptoms include hives, difficulty breathing, swelling of your face or throat, fever with a severe blistering and peeling rash.
- Vision problems: Blurred vision or other vision changes can be caused by either drug. If you notice any changes in your sight while taking these drugs, contact your doctor immediately.
- Cardiovascular issues: Fast heartbeats or fluttering chest sensations could indicate a serious side effect related to the cardiovascular system for users of either medication.
- Low sodium levels (hyponatremia): This symptom is more commonly associated with Depakote use. It's characterized by symptoms such as headache, confusion slurred speech, weakness vomiting loss coordination feeling unsteady
- Severe nervous system reaction: With both medications there's a possibility of experiencing rigid muscles high fever sweating confusion fast uneven heartbeats tremors feeling like might pass out Any symptoms serotonin syndrome while rare could manifest when using Lamictal agitation hallucinations fever sweating shivering fast heart rate muscle stiffness twitching loss coordination nausea vomiting diarrhea.
If you experience any of these side effects while taking Lamictal or Depakote it's important to seek medical attention right away.
What are the most common side effects for Depakote?
Individuals taking Depakote may experience a range of side effects:
- Upset stomach, nausea, vomiting or loss of appetite
- Dizziness or drowsiness
- Unusual weight changes
- Hair loss
- Changes in menstrual periods
- Shaking (tremor)
- Enlarged breasts in men Changes in mood and mental health can also occur such as confusion, depression, hallucinations. Some patients report problems with vision like blurriness. In some cases, increased urination frequency might be observed. Serious rashes are rare but possible. It's important to consult your healthcare provider if you notice any unusual reactions after starting Depakote.
Are there any potential serious side effects for Depakote?
Although Depakote is generally well-tolerated, there are some serious side effects that you should be aware of. These include:
- Signs of liver problems: nausea, upper stomach pain, itching, loss of appetite, dark urine, clay-colored stools or jaundice (yellowing of the skin or eyes).
- Symptoms related to a severe skin reaction: fever, sore throat, swelling in your face or tongue along with burning eyes; red/purple skin rash that spreads and causes blistering/peeling.
- Increased suicidal thoughts and unusual changes in mood.
- Confusion or disorientation.
- Changes in vision including blurred vision; experiencing halos around lights.
- Unexplained bleeding/blood spots under the skin accompanied by a fever.
If you experience any of these symptoms while on Depakote therapy immediately contact your healthcare provider.
Contraindications for Lamictal and Depakote?
Both Lamictal and Depakote, like many other medications for mood disorders, may potentially worsen symptoms in some individuals. If you notice your symptoms worsening or experience an increase in suicidal thoughts or behaviors while taking these drugs, please seek immediate medical help.
Neither Lamictal nor Depakote should be taken if you are currently on or have recently stopped using monoamine oxidase inhibitors (MAOIs). Always inform your doctor about all the medications you are taking; MAOIs require a period of about 5 weeks to clear from your system entirely, preventing dangerous interactions with Lamictal and Depakote.
How much do Lamictal and Depakote cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Lamictal (100 mg) averages around $700, which works out to $12–$23/day, depending on your dose.
- The price for a supply of 30 tablets Depakote ER (500mg), is approximately $270; this works out to about $9/day.
Thus, if you are in the higher dosage range for Lamictal (i.e., 200 mg/day or higher), then brand-name Depakote is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
In terms of generic options:
- Generic lamotrigine can be found at prices as low as around $8 for a pack size of 30 x 100mg tablets ($0.27 - $.53 /day).
- Valproic acid, the equivalent generic version for Depakote, starts from roughly $15 for a supply amounting to thirty capsules/tablets at strength level:500 mg ($0.50 -$1 / day).
Remember: cost alone should not guide your medication decision-making process; effectiveness and side effects must also be considered.
Popularity of Lamictal and Depakote
Lamotrigine, also known by the brand name Lamictal, was estimated to have been prescribed to about 3.5 million people in the US in 2020. It accounted for approximately 7% of antiepileptic prescriptions in the US that year. Although not exclusively used as a mood stabilizer, it has gained popularity among psychiatrists over traditional "mood-stabilizing" antiepileptics due to its efficacy and relatively benign side effect profile. The prevalence of lamotrigine has seen an upward trend since its introduction.
On the other hand, valproic acid (Depakote) was prescribed to nearly 2 million individuals in the USA during that same period. Valproic acid holds just under 4% of overall antiepileptic medication prescriptions but is more commonly used as a mood stabilizer compared with lamotrigine. This drug's usage rate remains stable without significant growth or decline over recent years.
Conclusion
Both Lamictal (lamotrigine) and Depakote (divalproex sodium) have long-standing records of usage in patients with bipolar disorder, backed by numerous clinical studies and meta-analyses indicating that they are more effective than placebo treatments. In some cases, the drugs may be combined, but this is subject to careful consideration by a physician due to potential drug interactions between them. Their mechanisms of action differ; Lamictal primarily works as an anticonvulsant while also stabilizing mood swings, whereas Depakote acts as both an anticonvulsant and mood stabilizer working on GABA neurotransmitters.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out of pocket. Both Lamictal and Depakote may require an adjustment period meaning effects may not be noticeable right away.
The side effect profile differs between these two drugs: common side effects for Lamictal include dizziness, headache, blurred vision or double vision while those for Depakote can include nausea, vomiting or changes in weight. For both medications, patients must closely monitor their moods when starting treatment and should seek medical help immediately if they notice their condition worsening or begin having suicidal thoughts.
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Refrences
- Goa, K. L., Ross, S. R., & Chrisp, P. (1993, July). Lamotrigine. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-199346010-00009
- Bhagwagar, Z., & Goodwin, G. M. (2005, July). Lamotrigine in the treatment of bipolar disorder. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.6.8.1401
- Prica, C., Hascoet, M., & Bourin, M. (2008, August). Antidepressant-like effect of lamotrigine is reversed by veratrine: A possible role of sodium channels in bipolar depression. Behavioural Brain Research. Elsevier BV.http://doi.org/10.1016/j.bbr.2008.03.007
- Malik, S., Arif, H., & Hirsch, L. J. (2006, November). Lamotrigine and its applications in the treatment of epilepsy and other neurological and psychiatric disorders. Expert Review of Neurotherapeutics. Informa UK Limited.http://doi.org/10.1586/14737175.6.11.1609
- Haymond, J., & Ensom, M. H. H. (2010, February). Does Valproic Acid Warrant Therapeutic Drug Monitoring in Bipolar Affective Disorder?. Therapeutic Drug Monitoring. Ovid Technologies (Wolters Kluwer Health).http://doi.org/10.1097/ftd.0b013e3181c13a30