Antisuicidal Effect of Lamotrigine Augmentation in Treatment-Resistant Depression: A Case Report

Treatment-resistant depression (TRD) is a serious public health burden in the United States and comes with an extremely high suicide risk relative to the general population. Lamotrigine, though approved for use only in bipolar disorder, has been found to augment the effects of an antidepressant in treatment-resistant individuals. However, studies showing an antisuicidal effect of lamotrigine in the TRD population are limited. The objective of this paper is to describe a case of a 58-year-old male with TRD and chronic suicidality who was treated with lamotrigine augmentation of the serotonin-norepinephrine reuptake inhibitor, duloxetine, and experienced a sustained clinical improvement of his suicidality.

Clinical changes in depression and suicidality after initiation of lamotrigine are presented.

The patient experienced a brief improvement in depression and sustained improvement in suicidality for 2 years.

While there remains insufficient evidence in the literature for a clinical recommendation of the use of lamotrigine for suicidality in the TRD population, our case report introduces the novel possibility of an antisuicidal effect of lamotrigine at the individual level. We suggest clinicians consider its use when other, more robust treatments for suicidality have failed.