Does Lamictal Help with Anxiety? An In-Depth Look at Off-Label Use

October 8, 2025 •

2 min read

Approximately one-third of individuals with bipolar disorder also experience a comorbid anxiety disorder. While Lamictal (lamotrigine) is primarily a mood stabilizer used for bipolar disorder and epilepsy, the question of does Lamictal help with anxiety often arises, particularly in cases where anxiety symptoms are intertwined with mood instability. Prescribing this medication specifically for anxiety is considered an off-label use.

Quick Summary

Lamictal is not a first-line treatment for anxiety disorders and lacks robust evidence for this use. While it may indirectly help anxiety linked to mood instability, it can also cause or worsen anxiety as a side effect. Clinicians use it cautiously, often only when standard treatments have failed or in patients with comorbid bipolar disorder.

Key Points

Limited Evidence: Lamictal's use for primary anxiety disorders is not well-supported by strong scientific evidence.
Off-Label Use: The use of Lamictal specifically for anxiety is considered an off-label use and is not FDA-approved.
Indirect Benefit for Comorbidity: Lamictal may help reduce anxiety in patients with comorbid bipolar disorder by stabilizing their mood.
Risk of Worsening Anxiety: For some individuals, Lamictal can cause or exacerbate anxiety, especially during titration, requiring careful monitoring.
Different Mechanism: Lamictal stabilizes mood by affecting sodium channels and glutamate, which is different from the serotonin-focused mechanism of typical anti-anxiety medications.
Not First-Line: Standard treatments like SSRIs, SNRIs, and psychotherapy have much stronger evidence and are recommended as first-line therapies for anxiety.

Understanding Lamictal's Primary Uses

Lamictal (lamotrigine) is FDA-approved for treating certain seizures in epilepsy and as a maintenance treatment for bipolar I disorder, particularly for preventing depressive episodes. Its mechanism involves affecting voltage-sensitive sodium channels and reducing glutamate release to stabilize neuronal activity and regulate mood.

The Off-Label Use of Lamictal for Anxiety

Using Lamictal for anxiety is considered off-label as it's not an FDA-approved indication. Some psychiatrists might use it off-label when anxiety is linked to a mood disorder or resistant to other treatments, hypothesizing that mood stabilization could indirectly reduce anxiety.

Potential Benefits in Comorbid Conditions

Targeting mood-related anxiety: Lamictal's mood-stabilizing effect may reduce anxiety linked to mood instability.
Treatment-resistant cases: It may be an option when standard anxiety medications are ineffective.
Lower dependence risk: Unlike benzodiazepines, Lamictal has a low dependence risk for long-term use in specific situations.

Risks and Limited Evidence for Primary Anxiety

Lamictal is not a recommended treatment for primary anxiety disorders like GAD or Social Anxiety Disorder without underlying mood instability.

Worsening Anxiety as a Side Effect

Anxiety is a known side effect of Lamictal, which can manifest as increased restlessness or agitation. Monitoring is crucial, and discontinuation may be necessary if anxiety significantly worsens.

Potential Side Effects of Lamictal

Other side effects include dizziness, drowsiness, headaches, nausea, insomnia, and a rare but serious skin rash (Stevens-Johnson syndrome). The dose must be increased slowly to minimize rash risk.

Research Findings

Evidence for Lamictal's efficacy in primary anxiety is limited to small studies and anecdotal reports, with most trials not showing significant effectiveness. This contrasts with the strong evidence for standard anxiety treatments like SSRIs and SNRIs.

Comparison Table: Lamictal vs. Standard Anxiety Medications

A comparison of Lamictal with standard anxiety medications highlights key differences {Link: Dr.Oracle AI https://www.droracle.ai/articles/36221/can-lamictal-be-used-for-anxiety}.

Conclusion: A Cautious and Specific Approach

Lamictal is generally not the first choice for anxiety due to limited evidence and the risk of worsening symptoms. Decisions about off-label use require careful consideration with a healthcare provider, prioritizing established, evidence-based anxiety treatments first.

For more information on evidence-based treatments for depression and anxiety, the Mayo Clinic is an excellent resource.

Frequently Asked Questions

No, Lamictal (lamotrigine) is not a first-line treatment for anxiety disorders. Standard treatments like SSRIs and SNRIs are recommended first, as they have much more robust evidence supporting their effectiveness.

Yes, for some people, Lamictal can cause or worsen anxiety, especially when starting the medication or adjusting the dose. The FDA drug label lists anxiety as a potential adverse effect.

In patients with bipolar disorder, Lamictal's mood-stabilizing effects can help regulate mood swings. This can have an indirect effect of reducing anxiety symptoms that are linked to or triggered by mood instability.

Lamictal works primarily by stabilizing electrical activity in the brain through voltage-sensitive sodium channels and reducing glutamate release. This differs from most traditional anxiety medications, which primarily modulate serotonin, norepinephrine, or GABA systems.

Abruptly stopping Lamictal is not recommended and can potentially trigger seizures, especially in those with a history of epilepsy. Any discontinuation should be done gradually under medical supervision.

Common alternatives with strong evidence for treating anxiety include selective serotonin reuptake inhibitors (SSRIs) like sertraline (Zoloft) and escitalopram (Lexapro), and serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine (Effexor XR).

Since the dosage of Lamictal is increased slowly over several weeks to minimize the risk of serious side effects like a rash, it can take months before its full therapeutic effects are noticeable.