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Lamotrigine is Effective, Well Tolerated Maintenance Treatment for Bipolar Disorder
A DGReview of :"Latest maintenance data on lamotrigine in bipolar disorder"
European Neuropsychopharmacology
09/18/2003
By Deanna M Green, PhD
Lamotrigine, an anticonvulsant, is a well tolerated treatment that prevents both manic and depressive mood episodes, and may be complementary to lithium in the maintenance treatment of bipolar I disorder.
Optimal benefits can be achieved in the management of bipolar disorder with early and long-term treatment. One standard treatment is the use of lithium therapy to control mood episodes. However, recent studies have also implicated a role for lamotrigine in the treatment of hypobipolar depression and in a refractory variant of bipolar disorder accompanied by rapid cycling.
Joseph R Calabrese at Case Western Reserve University School of Medicine, Cleveland, Ohio, United States, and colleagues evaluated the use of lamotrigine in the maintenance treatment of bipolar I disorder.
The prospective study included 1315 patients (average age 43) with bipolar I disorder who were randomised to receive lamotrigine monotherapy (50 to 00 mg/day), lithium (serum levels 0.8 to 1.1 mmol/L), or placebo for 18 months. Efficacy was assessed by time to additional intervention for any mood episode.
Overall, both lamotrigine and lithium significantly increased the time to intervention for any mood episode over that observed for placebo. Specifically, the average time to additional intervention was 28 weeks for lamotrigine, 26 weeks for lithium and 12 weeks for placebo.
Further analysis revealed that only lamotrigine effectively prevented the need for intervention of a depressive mood. In addition, both lamotrigine and lithium were effective against manic episodes, though lithium was significantly more effective than lamotrigine.
The adverse-event profile for lamotrigine was similar to that of placebo, while patients receiving lithium reported higher rates of diarrhoea and tremor than those receiving lamotrigine. Furthermore, more lithium-treated patients discontinued due to adverse events.
The authors conclude that "lamotrigine is an effective and well-tolerated maintenance treatment for bipolar I disorder," and that lamotrigine and lithium have "potentially complementary mood stabilising properties."
Eur Neuropsychopharmacol 2003;13:Suppl 2:57-66.
"Latest maintenance data on lamotrigine in bipolar disorder"
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