Lamictal vs Lithium: Which is Right For You?

Bipolar disorder is a mood disorder that causes extreme mood swings from depression to mania to hypomania. An estimated 1% of the population — roughly 2.3 million people in the United States — are living with bipolar depression. Once known as manic depression or manic-depressive disorder, bipolar disorder can disrupt life, negatively affect relationships, and impact your sense of self-worth. Periods of extreme lows (depression) and manic highs (mania) can last for a week or longer and cause radical shifts in your mental health with energy, mood, and behavior. 

Finding the right bipolar disorder medication to treat symptoms is essential if you want to get back to living a healthy life with rewarding relationships. Two commonly prescribed drugs used to treat bipolar disorder are Lithium and Lamictal (lamotrigine). 

Lithium and Lamictal are each in different classes of drugs, so they don’t work in the same way to treat symptoms of bipolar disorder. Which one works best for you will depend on numerous factors, including the severity of symptoms, co-existing conditions, other aspects of a treatment plan, and more. 

Learning more about Lamictal vs. Lithium will help you make an informed decision about how to treat bipolar disorder. Together with your doctor, you can find an effective medication that works for you.  

Understanding Lamictal vs Lithium

Lamictal and Lithium stand out as two commonly prescribed options to treat symptoms of bipolar disorder. Each has a unique mechanism of action and benefits, but how a drug works for one person might not be how it works for another. Exploring the differences between Lithium and Lamictal can help you discuss which one to try with your healthcare provider.

Lamictal

Lithium is in the class of triazine anticonvulsants and is believed to work by stabilizing electrical activity in the brain to prevent or reduce mood swings. 

Some research suggests that Lamictal acts on serotonin reuptake, which can offer antidepressant effects. Lamictal is more effective in treating depressive symptoms of bipolar than it is in treating manic symptoms.  

FDA-approved uses for Lamictal

The Food and Drug Administration (FDA) approved Lamictal to treat epilepsy as well as bipolar disorder. 

Benefits of Lamictal

Lamictal reduces the risk of bipolar depressive episode relapse by delaying mood changes. Prevention is probably its most significant benefit, and it’s also one of the only drugs that treat bipolar by lifting depressive symptoms instead of suppressing mania. 

Lamictal is more widely used to treat the depressive side of bipolar and might not be the best option for those with active hypomania or mania. A significant upside to Lamictal mood stabilizers is it’s well-tolerated. 

Lithium

Lithium is a mood stabilizer that treats bipolar disorder symptoms by regulating sodium transport that affects mania. It’s believed that Lithium is effective because it can reduce inflammation in the brain. Lithium is known to regulate mood swings and manic episodes to minimize aggression, poor judgment, hyperactivity, and the feeling that you don’t need sleep.  

FDA-approved uses for Lithium

The Food and Drug Administration (FDA) approved Lithium to treat bipolar disorder symptoms, including acute manic and mixed episodes, as well as maintenance in people seven years and up. 

Benefits of Lithium

Benefits of Lithium include the ability to reduce manic symptoms of bipolar disorder. Some research shows Lithium might be the only drug that’s effective in preventing mood, depressive, and manic episodes. It’s also shown to reduce suicide risk in some people.  

“Lamictal is one of the best-tolerated mood stabilizers with little weight gain and is often used for bipolar depression. Lithium is best for bipolar mania and specifically decreasing suicidal thoughts. Lithium is often underutilized because of Lithium’s side effects that include weight gain, tremors, and possible effects on the thyroid.”

– Talkspace psychiatrist Dr. Dion Metzger

Brand NameLithiumLamictalGeneric NameLithium carbonateLamotrigineUses — FDA ApprovedBipolar disorder – manic episodesLong-term bipolar maintenanceBipolar disorderSeizure disordersOff-label UsesMajor depressive disorder (as adjunct therapy)Bipolar without maniaNeutropeniaVascular headachesUnipolar depression (a major depressive episode)Side EffectsDiarrheaNauseaDry skinDry mouthIncreased thirstMetallic taste in the mouthMild hand tremorsDrowsinessLithium weight gain  Headache
Dizziness
Agitation
Diarrhea
Nausea or vomiting
Feeling drowsy
Aggression or irritability
Shaking or tremors
Difficulty sleeping
Mild skin rash
Dosage Forms/StrengthsForms:
Capsules
Tablets
Oral consumption
Oral syrup
Compounding powder
Extended-release

Strength:
150mg
300mg
450mg
600mg
300mg/5L
Forms:
Tablets
Chewable tablets
Orally disintegrating

Strength:
2mg
5mg
25mg
50mg
100mg
150mg
200mg
250mg
300mg
Key considerations
Note that Lithium can impair reactions.
Do not drive or use machinery until you know how Lithium will impact your reactions.
Watch your sodium intake.
Keep hydrated.

Avoid alcohol when taking Lamictal.
Watch for serious allergic reactions, including rashes.
Do not crush, chew, or break tablets.

Efficacy in Treating Bipolar Disorder

Gauging efficacy in treating bipolar disorder with Lamictal vs Lithium depends on what part of the condition you’re using medication for. In some research, both drugs were found to be superior to the placebo when assessing time to intervention for any mood episode, and studies conclude that both are effective monotherapy for bipolar II depression.  

Manic episodes: Lithium appears to be better at preventing recurring manic or hypomanic episodes. 
Depressive episodes: Lamictal is better at treating bipolar depression and delaying the time between episodes. 
Maintenance: Studies suggest that Lithium is effective as the first line of treatment in acute and maintenance treatment of bipolar disorder. Additionally, Lithium is the only drug that’s shown to reduce death by suicide in people with bipolar. 

Considerations for Choosing Between the Two

Several factors can influence the decision to take Lamictal vs Lithium. 

“A discussion with a medical professional will be helpful in choosing between Lamictal and Lithium. A patient’s medical history, severity of current symptoms, and availability to have bloodwork done (necessary for Lithium) are all considered in choosing the best mood stabilizer.”

– Talkspace psychiatrist Dr. Dion Metzger

Ratings

Lamictal has a slightly higher rating (76% of Lamictal users vs 65% of Lithium users report a positive experience).  

Pre-existing health conditions

Lamictal has fewer known drug interactions (284 compared to Lithium’s 708), and there’s a striking difference with “major” interactions (9 with Lamictal vs 177 with Lithium). 

Potential side effects and limitations

While not universal, Lithium can cause weight gain in some people. Clinical trials show weight gain is even less common when taking Lamictal. Both drugs can cause difficulty focusing or concentrating and impair judgment and clear thinking. Lamictal is a Category C drug, meaning risk if used while pregnant can’t be fully ruled out. Lithium is a Category D drug, which means there’s evidence of risk when pregnant. 

Lifestyle considerations and medication adherence

You shouldn’t drink alcohol when taking either drug, as both can cause drowsiness and dizziness that could be exacerbated when drinking. Do not take more than the suggested dose of either Lamictal or Lithium — take both medications as directed by your doctor. 

Lithium blood testing

A unique aspect of Lithium treatment is the necessity for regular blood tests. These tests monitor Lithium levels in the blood to ensure they remain within a therapeutic range and check kidney and thyroid function, which Lithium can affect. 

This requirement for ongoing monitoring can influence the choice between medications, considering the added commitment and potential health implications of long-term Lithium use.

Determine if Lamictal or Lithium Is Right for You 

Only you and your doctor can decide if Lamictal or Lithium is the better option to treat bipolar disorder. If you need help determining the right course of treatment, Talkspace has licensed psychiatrists who can prescribe Lamictal or Lithium online if appropriate. Talkspace makes getting help for mental health simple, convenient, and affordable. 

Reach out today to connect with an online psychiatrist about Lamictal and Lithium.