Lamictal & Emotional Numbness
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Q:  Lamictal & Emotional Numbness

Hello Dr. Phelps

My companion has been on and off antidepressants for years until he tried Lamictal (100 mg). He is now sleeping better and feels much better as far as the depression is concerned. My concern is that he has developed a sort of emotional numbness to myself and those around him. I am glad that he is not depressed, especially in the morning, but he seems aloof and somewhat unaffected by things and people around him. He was never like this in the past, so that is why we are concerned.  Any insights into this matter would be greatly appreciated. Thanks for the great website.

Dear Mr. C' --
Well that's interesting. This is the kind of thing that people report very commonly about serotonergic antidepressants like fluoxetine (formerly Prozac), paroxetine (formerly Paxil), citalopram (formerly Celexa) and that crowd. "Apathy" is the usual descriptive term. It can be very subtle, so that even the person taking the medication may take a while to figure out he's different, just not caring strongly about much of anything. 

But I've not heard that reported (in the literature, nor to me by my patients taking lamotrigine (Lamictal)). Lithium can cause something perhaps similar, what patients describe as "dullness", where they lose a sort of spark, a glimmer in their style, an excitement, especially in their way of thinking ("zip" or speed or clarity or ability to connect ideas, something along those lines). What you're describing doesn't exactly sound like that either, though. 

So unfortunately, this is one of those replies where the short answer would be "I don't know". But I hate saying that, and thus you get this approach. One other angle that might be relevant: at higher doses like 300 or 400 mg daily, people can get a problem with thinking clearly. this too can be very subtle, enough so that they don't know they're really not thinking properly. Sometimes it's just a problem remembering names, or stringing together a long sentence (e.g. losing the beginning before getting to the end). So there is a sort of dulling there, as well, but it's much more specific to thinking ability. 

I suppose you could wonder whether the old version of your companion was a rather hypomanic one (some people just kind of live up there, most of the time.  Many, but not all, then periodically have severe depressions as well. If the treatment was to remove some of that hypomanic component, your friend might look pretty dull compared to what you're used to. But I don't think this is what you're describing, as "numb" is not the word people use when talking about this phenomenon. Ultimately he may have to decide whether to risk having old symptoms come back, by tapering off the lamotrigine, to see the difference himself (now versus old self). Of course that must be done only with the psychiatrist or prescriber well aware of what's going on and with a good plan for some alternative treatment in place, or perhaps even phasing that one in before phasing the lamotrigine out; certainly not on one's own, right? Okay. Good luck figuring it out. 

Dr. Phelps

Published October, 2006


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