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Am Fam Physician. 2022;106(3):249-250

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Is lamotrigine (Lamictal) as effective and safe as lithium for the maintenance treatment of bipolar disorder?

Evidence-Based Answer

Compared with placebo, lamotrigine reduces the recurrence of manic symptoms at one year and the need for additional psychotropics necessitated by worsening clinical symptoms. (Strength of Recommendation [SOR]: B, inconsistent or limited-quality patient-oriented evidence.) The adverse effect profile of lamotrigine is similar to that of placebo.1 (SOR: B, inconsistent or limited-quality patient-oriented evidence.)

Compared with lithium, lamotrigine is similarly effective at treating recurrences of depressive episodes and any episode requiring additional psychotropic therapy, but it is less effective at reducing the recurrence of manic episodes at one year. (SOR: B, inconsistent or limited-quality patient-oriented evidence.) Patients using lamotrigine have fewer reported adverse effects and withdrawals from treatment compared with those using lithium.1 (SOR: A, consistent, good-quality patient-oriented evidence.)

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These are summaries of reviews from the Cochrane Library.

This series is coordinated by Corey D. Fogleman, MD, assistant medical editor.

A collection of Cochrane for Clinicians published in AFP is available at

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