Only - Lamictal™ (lamotrigine) is effective in certain types of treatment resistant depression. I have seen it used sucessfully in several cases of treatment resistant bipolar depression. Lamotrigine is actually marketed as an anticonvulsant and is used for epilepsy, but like so many other anticonvulsants (eg. Epival™/Depakote™ - divalproex; Tegretol™ - carbamazepine; Neurontin™ - gabapentin) lamotrigine is used as a mood stabilizer and also helps prevent the manic and depressive swings in bipolar disorder. Of all of the mood stabilizers, in my opinion, lamotrigine has the best antidepressant activity.

The rash that your psychiatrist is talking about is a serious, but uncommon side effect of lamotrigine. The rash is called "Stevens-Johnson Syndrome" (SJS) and can be life threatening and can occur if the dose of lamotrigine is increase too quickly. That being said, those that are most at risk of getting SJS are young children and the elderly.

The rash is important to know about, but starting with a low dose and increasing the dose slowly this side effect is hardly ever seen. In 20 years I have seen 4 possible and 2 confirmed cases, and only 2 of those "possible" cases were in people taking lamotrigine. These 2 people developed a rash after starting lamotrigine, but whether the rash was SJS was debateable. The skin doc thought that one of the cases was a mild allergic reaction to lamotrigine, rather than SJS.

I'd say give the lamotrigine a try; as for dosing, just start low and increase the dose slowly, over time. Let us know how it goes.

I hope that this helps. - Cam