Lamictal for Panic disorder

There are several well known medications that are utilized such as benzodiazepines, SSRI’s and TCA’s. One new medication I have found success with in refractory and severe cases isLamictal.

It has never been formally looked at for anxiety or panic disorder. After using it for patients struggling with Bipolar depression, I noticed a consistent improvement in anxiety symptoms and panic symptoms in several patients so I began trying this as monotherapy in panic disorder and panic attack patients that I see in my practice in Scottsdale.

It is desirable for many reasons but one of the largest one besides it being efficacious, is the extremely good side-effect profile.  The benzodiazepines are addictive and only effective short-term before building tolerance, the SSRI’s can cause a variety of bothersome side-effects and this often leads to people not staying with the medications even if they do work.  Lamictal on the other hand causes minimal side-effects and is extremely well tolerated.

The mechanism of action is interesting and unique among the approach to anxiety. Its primary mechanism of action in the brain is blockade of pre-synaptic neuronal sodium channels, especially in parts of the brain which are responsible for our primitive “fear” response-the limbic system.  By modulating sodium channels there is a two-fold benefit. First, blocking sodium channels blocks the neurons ability to fire an electrical impulse which in turn makes circuits in the brain less active and not over-active such is the case in a disorder like anxiety and panic. Second, by modulating other sodium channels that are responsible for modulating glutamate activities (a potentially neurotoxic neurotransmitter which is elevated in long-standing anxiety or acute panic). The net effect is reduction in glutamate levels and again, the effect is most prominent in the limbic system which is responsible for the most bothersome, uncomfortable symptoms of fear and panic.  By lowering glutamate, there is a protective effect offered by decreasing the net damage inflicted on the brain circuitry fear cycle, and thus I have seen this medication prevent the future return of symptoms.

 

Michael Yasinski MD