Does Lamotrigine Affect Sex Drive? What the Studies Actually Show
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Does lamotrigine affect sex drive? The pooled evidence does not show it moving desire or sex hormones the way the older enzyme-inducing seizure drugs do. A 2025 systematic review of antiseizure medications in men with epilepsy found no evidence of differences in any outcomes between levetiracetam or lamotrigine and comparison groups, while oxcarbazepine raised testosterone, luteinizing hormone and follicle-stimulating hormone against healthy controls. A 2025 pooling of 33 studies found no significant change in sex hormone binding globulin for lamotrigine in men and a reduction in women, opposite in direction to phenytoin and carbamazepine. A randomized six-month comparison in 38 men found no change in sexual function or sex hormones. The large signal sits with the conditions underneath: epilepsy itself was associated with a pooled relative risk of 2.69 for sexual difficulty in women and 4.85 in men.
Read this part first
Do not stop or change your medication without your doctor. Stopping lamotrigine on your own can bring seizures back and can set off a mood relapse, and any dose change belongs to your prescriber. Nothing here is a reason to skip tonight's pill. It is a reason to book a conversation.
- A 2025 review of antiseizure drugs in men with epilepsy, 32 studies reviewed and 22 pooled, found no evidence of differences in any outcomes between levetiracetam or lamotrigine and comparison groups. The authors ask for cautious reading: many analyses held only a few studies and high heterogeneity.
- Across 33 studies of single-drug therapy, sex hormone binding globulin was raised by phenytoin in men (SMD 1.36), carbamazepine (men 0.71, women 0.54) and oxcarbazepine (men 0.62). Lamotrigine showed no significant change in men and a reduction in women (SMD -0.50, 95% CI -0.85 to -0.16), one pooled estimate and nothing more.
- Epilepsy itself was associated with sexual difficulty at a pooled relative risk of 2.69 in women (95% CI 1.48 to 4.89) and 4.85 in men (2.01 to 11.7), across nine observational studies of 1,556 subjects. GRADE moderate.
- In bipolar disorder, a 2026 review of 37 studies and 8,724 people found sexual difficulty reported in 14% to 91% of samples, present during euthymia and not only in mood episodes. In the one comparison of regimens, the anticonvulsant arm pooling valproate and lamotrigine scored better than lithium alone, in a cross-sectional design.
Figures from Zhao 2019 (PMID 30639977), Couper 2025 (PMID 40325998) and Kanojia 2025 (PMID 39693860). All three pool observational data, so every figure is an association.
"Is it the lamotrigine, or is it me?"
Type the question into a search bar and the internet answers with total confidence. Lamotrigine flattened your libido, here is the stack that brings it back. The research is quieter, and it points somewhere else.
Lamotrigine, sold as Lamictal, is the drug people search hardest about and the one with the least signal against it. Two 2025 poolings and one randomized comparison all failed to find it moving what gets measured, while the two conditions it is prescribed for both carry large measured associations with sexual difficulty.
So something real happened to your desire. The question is what to hang it on. This is the twelfth article in our medication series, after what doctors do not say about antidepressants and low libido, blood pressure medication and sex drive, statins and sex drive and Adderall and sex drive. Most of those end with a drug carrying a measurable share of the blame. This one does not, and that is the finding.
What the pooled evidence actually shows about lamotrigine
Couper and colleagues searched for studies measuring sex hormones, sexual function or sperm parameters in men with epilepsy on any antiseizure medication except valproic acid, each against a control group. Thirty-two studies made the review and 22 made the meta-analysis. Valproic acid was left out on purpose, since a review covering it appeared in 2018.
Men taking oxcarbazepine had significantly higher testosterone, luteinizing hormone and follicle-stimulating hormone than healthy controls. Against that, the review reports no evidence of differences in any outcomes between levetiracetam or lamotrigine and comparison groups.
Two caveats travel with that null and both come from the authors. Results should be read cautiously, because many analyses included only a few studies and had high heterogeneity. And analyses that included untreated men with epilepsy rarely differed from men taking medication, which the authors read as a sign of how much the epilepsy itself is doing.
The randomized evidence is small and points the same way. Wu and colleagues assigned 38 newly diagnosed men with epilepsy to oxcarbazepine, levetiracetam or lamotrigine, measured them before treatment and again six months in, and compared them with healthy volunteers. There was no significant difference in sexual function between patients and controls, and none before against after treatment on any of the three drugs. Sex hormones were flat too. Thirty-eight men across three arms is one honest data point.
The hormone question, and which drugs move it
Sex hormone binding globulin carries testosterone around and decides how much is free to do anything. Drugs that induce liver enzymes push it up, leaving less free testosterone in circulation. That is the mechanism behind most sexual complaints attributed to older seizure medications.
Kanojia and colleagues pooled 33 studies of people on a single antiseizure drug, against healthy controls and against people with epilepsy taking nothing. The enzyme inducers behaved as the mechanism predicts: phenytoin raised the protein in men at a standardized mean difference of 1.36 (95% CI 1.06 to 1.66), carbamazepine at 0.71 in men and 0.54 in women, and oxcarbazepine, a weak inducer, at 0.62 in men.
Valproic acid, lamotrigine and levetiracetam all showed no significant change in the protein in men. In women, lamotrigine significantly reduced it, at -0.50 (95% CI -0.85 to -0.16). Lower binding globulin means more free testosterone, opposite in direction to the drugs that get blamed for this. The same paper found testosterone reduced in men on carbamazepine (SMD -0.39) and on valproic acid (SMD -0.48). Lamotrigine appears in no testosterone finding, in either direction.
What each drug did to sex hormone binding globulin
Standardized mean differences against controls, from one paper, Kanojia et al. 2025. Zero is no difference. Orange marks lamotrigine.
Source: Kanojia N et al., Epilepsy & Behavior 2025 (PMID 39693860). 33 studies of single-drug therapy. Pooled observational data, so these are associations only.
Bipolar disorder and sex drive
Most people searching this take lamotrigine for bipolar disorder, so the bipolar literature matters more here. It is smaller, and worth knowing.
Garcia-Blanco and colleagues studied 114 bipolar outpatients in euthymia for at least six months, on mood stabilizers with no antipsychotics and no antidepressants. Four regimens were compared: lithium alone, anticonvulsants alone, lithium plus anticonvulsants, and lithium plus benzodiazepines. The anticonvulsant-only group had better total sexual function scores than the lithium-only and lithium-plus-benzodiazepine groups, and both lithium groups reported worse sexual desire.
The anticonvulsant arm pooled valproate and lamotrigine, so no figure there belongs to lamotrigine alone. And the design is cross-sectional, a snapshot of people already on their regimens, so it shows association and never a direction of cause. The authors name the design and the sample size as their main limitations. Being female and older age were both associated with worse scores.
The wider picture came in 2026. Canada and colleagues reviewed 37 studies covering 8,724 people with bipolar disorder and found reported prevalence of sexual difficulty ranging from 14% to 91%, a spread driven by sample, setting and treatment. Desire was the part most often affected. Against healthy controls, people with bipolar disorder showed poorer sexual functioning and satisfaction, and this held during euthymia and not only in mood episodes. The authors call it a core dimension of the illness, which puts the diagnosis ahead of the tablet as the thing to suspect. The review's authors say the mechanisms still need clarifying. The depressive pole of the illness is the obvious first place to look, and we wrote that up in depression and low libido.
What epilepsy itself does to desire
Zhao and colleagues pooled nine observational studies, 1,556 subjects with 599 cases of epilepsy, and calculated the risk of sexual difficulty against people without epilepsy. In women the pooled relative risk was 2.69 (95% CI 1.48 to 4.89) across six studies, heterogeneity 88.9%. In men it was 4.85 (95% CI 2.01 to 11.7) across three studies, heterogeneity 74.2%. Averaged across the pool, 383 of 659 people with epilepsy reported difficulty (58.1%) against 168 of 1,017 controls (16.5%). The authors graded the evidence moderate. Those heterogeneity figures are high and the men's interval, 2.01 to 11.7, is very wide, which is what three studies look like when reported honestly. The direction is not in doubt. The size is.
Rathore and colleagues wrote the narrative review that maps the causes. Nearly one half of men and women with epilepsy have sexual difficulty, and in most it goes unnoticed. Most likely to have it: people with uncontrolled epilepsy, longer duration, focal epilepsy, higher seizure frequency, and those on enzyme-inducing or multiple drugs. Women more often report the desire side. Depression and anxiety contribute significantly. On medication, the review says limited data suggest that newer drugs including oxcarbazepine, lamotrigine and levetiracetam cause no or minimal sexual dysfunction. It pools nothing, and "limited data" is the authors' own qualifier.
The suspect list, in order
When desire drops on lamotrigine, the evidence supports a running order. The tablet is on the list. It is last on it.
Four suspects, in the order the evidence ranks them
Bipolar disorder shows poorer sexual functioning than controls even in euthymia, across 37 studies. Epilepsy carries a pooled relative risk of 2.69 in women and 4.85 in men.
SSRIs and other antidepressants, antipsychotics, benzodiazepines, lithium, valproate and the enzyme-inducing seizure drugs all carry documented sexual effects. Lamotrigine is rarely the only thing in the drawer.
Broken sleep, exhaustion, and however many years of managing something demanding. None of it shows up in a pooled effect size, and all of it shows up in a bedroom.
Three analyses failed to find it moving sexual function or hormones. That is a null on thin data and never a promise about you. Individual reports exist.
Built from PMID 30639977, 40325998, 39693860, 32139195, 41930708 and 31577987. Every item is a question for a clinician.
Two limits belong with that ranking. The sexual-function evidence for lamotrigine is men only, so women taking it are asking a question the literature has barely looked at. And a null on a thin pool is not proof of no effect, so if the timing in your own life is unmistakable, say it out loud to your prescriber.
Which seizure medicines the evidence links to this
The split runs along whether a drug induces liver enzymes.
| Drug | What the pooled evidence shows | Population | Certainty |
|---|---|---|---|
| Phenytoin (enzyme inducing) | Binding globulin raised, SMD 1.36 (95% CI 1.06 to 1.66). The largest shift in the set | Men with epilepsy | Pooled observational data, 33 studies. Association only |
| Carbamazepine (enzyme inducing) | Binding globulin raised in men 0.71 (0.39 to 1.04) and women 0.54 (0.25 to 0.83). Testosterone lowered in men, -0.39 | Men and women with epilepsy | Same pooling. The only drug here with figures in both sexes and both hormones |
| Oxcarbazepine (weak inducer) | Binding globulin raised in men 0.62 (0.26 to 0.99). Separately, higher testosterone, LH and FSH than healthy controls | Men with epilepsy | Two independent 2025 reviews agree on the direction |
| Valproic acid | No significant binding globulin change in men. Testosterone lowered in men, -0.48 | Men with epilepsy | Excluded by design from the 2025 male sexual-function review, so that evidence is not in this set |
| Lamotrigine and levetiracetam | No significant binding globulin change in men. Lamotrigine lowered it in women, -0.50 (-0.85 to -0.16). No evidence of differences in any outcomes against comparison groups | Men and women with epilepsy; the sexual-function null is men only | Weakest of the set. The male null rests on few studies with high heterogeneity; the women's figure is one pooled estimate |
"I just want to feel normal again"
This is the reader the research serves worst. Mood stable for the first time in years, seizures quiet, everyone pleased with you, and your drive is nowhere to be found. Getting well was supposed to bring it back.
The first place to look is the rest of the prescription list. Lamotrigine is rarely prescribed alone. An SSRI alongside it is common, and antidepressants carry the best-documented sexual effects of any drug class in psychiatry, which we covered in the SSRI libido drop and, for people who came off one, in libido after stopping antidepressants. Lithium and benzodiazepines came out worse than anticonvulsants in the one bipolar comparison we have, and a blood pressure tablet or a statin makes it longer still.
Second, sleep. Broken sleep flattens desire in people with no diagnosis at all and it is near universal in both conditions, whether from the illness, the medication or the worry. The mechanism is in sleep, libido and testosterone, the tired-all-the-time bundle has its own guide in brain fog and sex drive, and the weight of carrying something for years is in stress, cortisol and sex drive.
And if your bloodwork came back unremarkable and you were sent home with nothing to work on, normal labs, low libido is written for that exact position. The wider map is in why is my libido so low.
What to take to your prescriber
The appointment will be shorter than you want, so take it in this order:
- Say it out loud in the first two minutes. Desire gets skipped when it waits until the end, and neither condition gets asked about routinely.
- Hand over the complete list, every prescription and every supplement. The pooled evidence points harder at what sits beside the lamotrigine.
- Ask for mood to be screened properly. Depression and anxiety contribute significantly in the epilepsy literature, and the bipolar review's authors say the mechanisms still need clarifying, which leaves depression the obvious first thing to screen.
- If you have epilepsy, ask whether your drug is enzyme-inducing. Phenytoin, carbamazepine and oxcarbazepine are the names to raise.
- Bring the timing. When it started, what else changed that month, what your sleep has been doing. Nobody else can supply that.
- Change nothing on your own. Do not stop or change your medication without your doctor, and that includes shaving a dose to test a theory.
The everyday levers, and where a botanical fits
Before anything else here: many people reading this are on more than one prescription. NUUD's own label says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. For a good share of the people who reach this page, that sentence is the whole answer. If you take a prescription for epilepsy or bipolar disorder, your prescriber decides whether any supplement belongs in the picture. Botanicals interact with medications.
Separate from anything clinical, a few ordinary things move desire in most people, and the free ones do more work than the internet admits.
- Sleep, in quantity and quality, defended like an appointment.
- Mood care taken as seriously as seizure control, since it is the contributor both literatures keep naming.
- A medication review with someone qualified, once a year.
- Movement you actually enjoy, which does its own separate work.
- Time and safety, alone or with a partner, with no expectation attached.
- A botanical supplement, if you want one and your prescriber has cleared it, as the smallest lever on the list.
NUUD is a botanical supplement built around desire in general. It does nothing for epilepsy, bipolar disorder, seizures or mood, and it has no role in managing a medical condition or in offsetting any drug. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, on a timeline of roughly 30 to 60 minutes. If your prescriber has read the label and has no objection, that is what our women's libido gummies are for, and there is a men's version of the same formula. Talk to your doctor first and bring the label.
"Nothing is wrong with you"
You have probably been handed two unhelpful answers already. One is a shrug in an appointment that stayed on your seizure count or your mood chart. The other is a confident voice online telling you the tablet stole your libido.
The research supports neither. Three analyses looked for lamotrigine moving sexual function or sex hormones and none found it, on thin data, mostly in men. The conditions it treats both carry large measured associations with low desire. The drugs that do move hormones are the older enzyme-inducing ones. That map is more useful than either answer you were given, and it puts most of the work in a room with a clinician in it.
If you have been quietly wondering whether you are broken: no. You are a person managing a serious condition, on a medication list, sleeping badly, and asking a reasonable question the research has barely bothered to study in women. Any one of those flattens wanting. Low libido in women and low libido in men walk through the rest of it.
Keep reading
- Depression and low libido
- The SSRI libido drop and what helps
- Normal labs, low libido
- Why is my libido so low?
Frequently asked questions
Does lamotrigine affect sex drive?
The pooled evidence does not show it moving desire or sex hormones the way the older enzyme-inducing seizure drugs do. A 2025 systematic review in men with epilepsy, 32 studies reviewed and 22 pooled, found no evidence of differences in any outcomes between levetiracetam or lamotrigine and comparison groups, while oxcarbazepine raised testosterone, luteinizing hormone and follicle-stimulating hormone. A pooling of 33 studies found no significant change in sex hormone binding globulin for lamotrigine in men and a reduction in women (SMD -0.50, 95% CI -0.85 to -0.16), and a randomized six-month comparison in 38 men found no difference in sexual function or sex hormones. That is thin data, mostly in men, and a null is never a promise about one person. Meanwhile epilepsy itself was associated with a pooled relative risk of 2.69 in women and 4.85 in men. Do not stop or change your medication without your doctor.
Is it the lamotrigine or is it the bipolar disorder?
The bipolar disorder has more evidence behind it. A 2026 review of 37 studies covering 8,724 people with bipolar disorder found sexual difficulty reported in 14% to 91% of samples, poorer functioning than healthy controls, and the difficulty persisting during euthymia, with desire the part most often affected. In the one study comparing regimens, 114 stable outpatients, the anticonvulsant-only group scored better than the lithium-only and lithium-plus-benzodiazepine groups. That study pooled valproate and lamotrigine into one arm and was cross-sectional, so it shows association and no direction of cause. The review's authors say the mechanisms still need clarifying, and the depressive pole of the illness is the first place to look.
Does epilepsy itself lower sex drive?
Yes, and by more than any of the newer drugs do. A meta-analysis of nine observational studies, 1,556 subjects with 599 cases of epilepsy, found a pooled relative risk of sexual difficulty of 2.69 in women (95% CI 1.48 to 4.89, six studies, I2 88.9%) and 4.85 in men (95% CI 2.01 to 11.7, three studies, I2 74.2%), GRADE quality moderate. Averaged across the pool, 383 of 659 people with epilepsy reported difficulty against 168 of 1,017 controls. A narrative review adds that nearly one half of men and women with epilepsy have sexual difficulty, with uncontrolled epilepsy, longer duration, higher seizure frequency, enzyme-inducing or multiple drugs, depression and anxiety among the named contributors.
Which seizure medications are most linked to sexual side effects?
The enzyme-inducing ones. Across 33 studies of single-drug therapy, sex hormone binding globulin was raised by phenytoin in men (SMD 1.36, 95% CI 1.06 to 1.66), carbamazepine in men (0.71) and women (0.54), and oxcarbazepine in men (0.62), which leaves less free testosterone in circulation. Testosterone itself came out lower in men on carbamazepine (SMD -0.39) and on valproic acid (SMD -0.48). A narrative review adds that limited data suggest the newer drugs including oxcarbazepine, lamotrigine and levetiracetam cause no or minimal sexual dysfunction. Valproic acid was excluded by design from the 2025 male sexual-function review.
Can I take a botanical supplement with lamotrigine?
Ask your prescriber first, before you buy anything. Botanicals interact with medications, and if you take a prescription for epilepsy or bipolar disorder, your prescriber decides whether any supplement belongs in the picture. NUUD is a botanical supplement built around desire in general and it has no role in epilepsy or bipolar disorder, does nothing for seizures or mood, and does nothing to offset any drug. Its label says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. Bring the label to the appointment.
References
- Zhao S, Tang Z, Xie Q, et al. Association between epilepsy and risk of sexual dysfunction: A meta-analysis. Seizure. 2019;65:80-88. https://pubmed.ncbi.nlm.nih.gov/30639977/
- Couper RG, Espino PH, Vicuna MP, Burneo JG. Effects of antiseizure medications on sexual hormones and functions in males with epilepsy: A systematic review and meta-analysis. Epilepsia. 2025;66(8):2639-2656. https://pubmed.ncbi.nlm.nih.gov/40325998/
- Kanojia N, Guin D, Machahary N, et al. Effect of antiepileptic drug monotherapy on endogenous sex hormonal profile in men and women with epilepsy. Epilepsy & Behavior. 2025;163:110220. https://pubmed.ncbi.nlm.nih.gov/39693860/
- Wu D, Chen L, Ji F, Si Y, Sun H. The effects of oxcarbazepine, levetiracetam, and lamotrigine on semen quality, sexual function, and sex hormones in male adults with epilepsy. Epilepsia. 2018;59(7):1344-1350. https://pubmed.ncbi.nlm.nih.gov/29889310/
- Garcia-Blanco A, Garcia-Portilla MP, Fuente-Tomas L, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. The Journal of Sexual Medicine. 2020;17(5):930-940. https://pubmed.ncbi.nlm.nih.gov/32139195/
- Rathore C, Henning OJ, Luef G, Radhakrishnan K. Sexual dysfunction in people with epilepsy. Epilepsy & Behavior. 2019;100(Pt A):106495. https://pubmed.ncbi.nlm.nih.gov/31577987/
- Canada Y, Navalon P, Zazula R, et al. Sexual dysfunction in bipolar disorder: A systematic review. European Neuropsychopharmacology. 2026;109:112827. https://pubmed.ncbi.nlm.nih.gov/41930708/
This article is for general education and is not medical advice. Epilepsy and bipolar disorder are medical conditions that only a licensed clinician can diagnose and manage. Do not stop or change your medication without your doctor, since stopping lamotrigine on your own can bring seizures back and can set off a mood relapse. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing epilepsy, bipolar disorder, or any other disease, and these statements have not been evaluated by the Food and Drug Administration. Talk with your doctor before starting any new supplement.
