Lamotrigine alternatives — March 2025 archive

This month on LetsGoPharm we focused on two practical topics: safe alternatives to lamotrigine for seizure and mood disorders, and the often-hidden link between trauma and opioid addiction. If you're weighing medication choices or supporting someone in recovery, these posts give clear, actionable takeaways.

Alternatives to lamotrigine

If lamotrigine isn’t working or isn’t suitable, you have options — but each comes with trade-offs. Valproate (valproic acid) is effective for seizures and bipolar disorder, but it carries real risks in pregnancy and weight gain. Carbamazepine helps focal seizures and some mood symptoms, though it can interact with other drugs and needs blood monitoring. Levetiracetam is popular because it’s easy to dose and has fewer interactions; some people get mood changes or irritability, so watch for that.

Oxcarbazepine is a milder cousin of carbamazepine with fewer interactions for many patients. Topiramate can reduce seizures and reduce migraine frequency, but cognitive side effects and weight loss are common. Choosing the right alternative depends on your diagnosis, sex and pregnancy plans, other meds you take, and how you tolerate side effects. Talk with your prescriber about goals: seizure control, mood stability, side effect profile, and blood test needs.

Practical tip: if pregnancy is possible or planned, discuss risks and safer options early. If mood stabilization is the priority, ask how each drug affects mood and behavior. Always review drug interactions with any other prescriptions or supplements you use.

Opioid addiction and trauma

The other March post looked at how trauma — emotional, physical, or developmental — often underlies opioid use. People use opioids for many reasons: pain relief, numbing upsetting memories, or coping with anxiety. When trauma is present, treating only the addiction misses a core driver of use.

Trauma-informed care changes how clinicians approach treatment: it screens for trauma, builds safety and trust, and avoids retraumatizing practices. Practical steps for recovery include combining medication-assisted treatment (like buprenorphine or methadone) with therapies that address trauma, such as trauma-focused CBT or EMDR. Peer support groups and case management for housing, legal, and medical needs also reduce relapse risk.

If you support someone with opioid dependence, validate their past without blaming, encourage integrated care, and help them find clinicians who understand trauma. If you're struggling personally, ask providers about trauma screening and combined treatment plans — addressing trauma often improves long-term outcomes.

Want a quick next step? For medication questions, list your current meds, symptoms, and priorities before your next appointment. For addiction concerns, check if local programs offer trauma-informed services or MAT plus therapy. Both posts this month aim to help you make informed, practical decisions about medication and recovery.