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Lamotrigine-induced obsessive-compulsive disorder in patients with bipolar disorder

  • Verinder Sharma (a1) (a2) and Minakshi Doobay (a2)



Lamotrigine is a commonly used drug in the treatment of bipolar disorder. Although there are reports of its effectiveness in the management of bipolar disorder and comorbid obsessive-compulsive disorder (OCD), lamotrigine has also been associated with obsessionality in patients with bipolar disorder.


Charts of 8 patients with bipolar disorder who had de novo onset of obsessions and compulsions after the use of lamotrigine were reviewed. The Naranjo scale was used to assess the likelihood of patients developing OCD due to lamotrigine use.


Two to 8 months after the initiation of lamotrigine, patients with no such prior history developed obsessions and compulsions meeting the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for medication-induced OCD. In all except 1 patient, the symptoms resolved within a month of lamotrigine discontinuation.


Some patients with bipolar disorder may develop OCD after initiation of lamotrigine. Due to the inherent limitations of a case series, the findings should be interpreted with caution.


Corresponding author

*Address for correspondence: Dr. Verinder Sharma, Parkwood Institute, Mental Health Care Building, 550 Wellington Road, London, ON N6C 0A7, Canada. (Email:


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The authors would like to thank Christine Baczynski at Parkwood Institute, London, Ontario, Canada for her assistance in manuscript preparation.



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1.Lamictal [package insert]. Greenville, NC: DSM Pharmaceuticals, Inc; 2009.
2. Yatham, LN, Kennedy, SH, Parikh, SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord. 2013; 15(1): 144.
3. Reid, JG, Gitlin, MJ, Altshuler, LL. Lamotrigine in psychiatric disorders. J Clin Psychiatry. 2013; 74(7): 675684.
4. Bruno, A, Mico, U, Pandolfo, G, et al. Lamotrigine augmentation of serotonin reuptake inhibitors in treatment-resistant obsessive-compulsive disorder: a double-blind, placebo-controlled study. J Psychopharmacol. 2012; 26(11): 14561462.
5. Khalkhali, M, Aram, S, Zarrabi, H, Kafie, M, Heidarzadeh, A. Lamotrigine augmentation versus placebo in serotonin reuptake inhibitors-resistant obsessive-compulsive disorder: a randomized controlled trial. Iran J Psychiatry. 2016; 11(2): 104114.
6. Poyurovsky, M, Glick, I, Koran, LM. Lamotrigine augmentation in schizophrenia and schizoaffective patients with obsessive-compulsive symptoms. J Psychopharmacol. 2010; 24(6): 861866.
7. Geddes, JR, Calabrese, JR, Goodwin, GM. Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. Br J Psychiatry. 2009; 194(1): 49.
8. Kemp, DE, Gilmer, WS, Fleck, J, Dago, PL. An association of intrusive, repetitive phrases with lamotrigine treatment in bipolar II disorder. CNS Spectr. 2007; 12(2): 106111.
9. Kuloglu, M, Caykoylu, A, Ekinci, O, Yilmaz, E. Lamotrigine-induced obsessional symptoms in a patient with bipolar II disorder: a case report. J Psychopharmacol. 2009; 23(8): 10011003.
10. Lombroso, CT. Lamotrigine-induced tourettism. Neurology. 1999; 52(6): 11911194.
11. Sotero de Menezes, MA, Rho, JM, Murphy, P, Cheyette, S. Lamotrigine-induced tic disorder: report of five pediatric cases. Epilepsia. 2000; 41(7): 862867.
12. Zaatreh, M, Tennison, M, D’Cruz, O, Beach, RL. Anticonvulsants-induced chorea: a role for pharmacodynamics drug interaction? Seizure. 2001; 10(8): 596599.
13. Szmulewics, AG, Valerio, MP, Smith, JM. Obsessive-compulsive symptoms in adjunctive therapy with lamotrigine in clozapine-medicated patients. Schizophr Res. 2015; 166(1-3): 364365.
14. Alkın, T, Onur, E, Özerdem, A. Co-occurrence of blepharospasm, tourettism and obsessive–compulsive symptoms during lamotrigine treatment. Prog. Neuropsychopharmacol. Biol. Psychiatry. 2007; 31(6): 13391340.
15. Lee, SA, Lee, HW, Heo, K, et al. Cognitive and behavioural effects of lamotrigine and carbamazepine monotherapy in patients with newly diagnosed or untreated partial epilepsy. Seizure. 2011; 20(1): 4954.
16. Naranjo, CA, Busto, U, Sellers, EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981; 30(2): 239245.
17. Lykouras, L, Alevizos, B, Michalopoulou, P, Rabavilas, A. Obsessive-compulsive symptoms induced by atypical antipsychotics. A review of the reported cases. Prog Neuropsychopharmacol Biol Psychiatry. 2003; 27(3): 333346.
18. Stamouli, S, Lykouras, L. Quetiapine-induced obsessive-compulsive symptoms: a series of five cases. J Clin Psychopharmacol. 2006; 26(4): 396400.
19. Tranulis, C, Potvin, S, Gourge, M, Leblanc, G, Mancici-Marie, A, Stip, E. The paradox of quetiapine in obsessive-compulsive disorder. CNS Spectr. 2005; 10(5): 356361.
20. Brakoulias, V, Starcevic, B, Belloch, A, et al. Comorbidity, age of onset and suicidality in obsessive-compulsive disorder (OCD): an international collaboration. Compr Psychiatry. 2017; 76: 7986.
21. Ruscio, AM, Stein, DJ, Chiu, WT, Kessler, RC. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010; 15(1): 5363.
22. Zaninotto, L, Solmi, M, Veronese, N, et al. A meta-analysis of cognitive performance in melancholic versus nonmelancholic unipolar depression. J Affect Disord. 2016; 201: 1524.
23. Fergus, TA, Valentiner, DP, McGrath, PB, Jencuis, S. Shame- and guilt-proneness: relationships with anxiety disorder symptoms in a clinical sample. J Anxiety Disord. 2010; 24(8): 811815.
24. Amerio, A, Stubbs, B, Odone, A, Tonna, M, Marchesi, C, Ghaemi, SN. The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review and meta-analysis. J Affect Disord. 2015; 186: 99109.
25. Rosenberg, DR, Mirza, Y, Russell, A, et al. Reduced anterior cingulate glutamatergic concentrations in childhood OCD and major depression versus healthy controls. J Am Acad Child Adolesc Psychiatry. 2004; 43(9): 11461153.
26. Yücel, M, Wood, SJ, Wellard, RM, et al. Anterior cingulate glutamate–glutamine levels predict symptom severity in women with obsessive-compulsive disorder. Aust N Z J Psychiatry. 2008; 42(6): 467477.
27. Wu, K, Hanna, GL, Rosenberg, DR, Arnold, PD. The role of glutamate signaling in the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol Biochem Behav. 2012; 100(4): 726735.
28. Cheung, H, Kamp, D, Harris, E. An in vitro investigation of the action of lamotrigine on neuronal voltage-activated sodium channels. Epilepsy Res. 1992; 13(2): 107112.
29. Ostadhadi, S, Ahangari, M, Nikoui, V, et al. Pharmacological evidence for the involvement of the NMDA receptor and nitric oxide pathway in the antidepressant-like effect of lamotrigine in the mouse forced swimming test. Biomed Pharmacother. 2016; 82: 713721.
30. Çökmüş, FP, Aşçıbaşı, K, Öztekin, S, Demet, MM. Relationship of levetiracetam and obsessive-compulsive disorder: a case report. Psychiatry and Clinical Psychopharmacology. 2017; 27(3): 325327.
31. Ozkara, C, Ozmen, M, Erdogan, A, Yalug, I. Topiramate related obsessive-compulsive disorder. Eur Psychiatry. 2005; 20(1): 7879.
32. El-Mallakh, RS, Gao, Y, Jeannie Roberts, R. Tardive dysphoria: the role of long term antidepressant use in-inducing chronic depression. Med Hypotheses. 2011; 76(6): 769773.
33. Sharma, V. Treatment resistance in unipolar depression: is it an iatrogenic phenomenon caused by antidepressant treatment of patients with a bipolar diathesis? Med Hypotheses. 2006; 67(5): 11421145.


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Lamotrigine-induced obsessive-compulsive disorder in patients with bipolar disorder

  • Verinder Sharma (a1) (a2) and Minakshi Doobay (a2)


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