Management of Low Motivation and Anhedonia in Patients on Lamotrigine

Medication Management

• The American Academy of Child and Adolescent Psychiatry suggests considering substance use disorders as a potential cause of anhedonia and low motivation in patients on lamotrigine 1
• The Annals of Oncology recommends starting bupropion at 150mg daily and titrating as needed while monitoring for side effects, due to its dopaminergic and noradrenergic effects 2
• Aripiprazole (5mg daily) may help with motivation due to its dopamine partial agonist properties, as suggested by the Annals of Oncology 2, 3
• Quetiapine (start with 25mg, titrate as needed) may be more effective for motivational symptoms, according to the Annals of Oncology and the Journal of the American Academy of Child and Adolescent Psychiatry 1, 2, 4
• Lithium has established efficacy for bipolar disorder and may be considered as an alternative mood stabilizer, as noted by the Journal of the American Academy of Child and Adolescent Psychiatry 1

Monitoring and Follow-up

• The Journal of the American Academy of Child and Adolescent Psychiatry recommends reassessing symptoms every 2-4 weeks after medication changes 1
• The Annals of Oncology suggests monitoring for potential side effects of any added medications 2