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Lamotrigine Shows Antidepressant Activity in Epileptic Patients: Presented at AAN

By Jill Stein

MIAMI, FL -- April 13, 2005 -- New data indicate that lamotrigine has antidepressant activity in epileptic patients who are slightly to moderately depressed but whose depression does not satisfy established criteria for a major depressive disorder.

Toufic Fakhoury, MD, associate professor of neurology, University of Kentucky, Lexington, Kentucky, United States, reported the results here on April 12^th at the American Academy of Neurology 57^th Annual Meeting.

People with epilepsy experience episodes of major depressive disorder with a lifetime frequency of about 29%, Dr. Fakhoury said. The figure appears to be similar in community samples (24.9%) and is higher than in another chronic disease comparison group, asthma, and about 8 times higher than seen in a no chronic disease group.

Dr. Fakhoury and his team evaluated 159 epileptic patients enrolled in a 36-week open-label trial that evaluated mood changes after lamotrigine adjunctive therapy to a stable antiepileptic drug treatment

All participants in the trial had epilepsy and depressive symptoms based on a Center for Epidemiological Studies Depression Scale (CES-D) score of 12 or greater. Patients were ineligible if they had a major depressive disorder as determined by a Mini International Neuropsychiatric Interview (M.I.N.I.) assessment.

At baseline, at the end of the adjunctive phase (week 19) and the monotherapy phase (week 36), patients were assessed using the Neurological Disorders Depression Inventory in Epilepsy (NDDI-E), Beck Depression Inventory (BDI-II), CES-D, Cornell Dysthymia Scale Self-Report (CDRS-SR), and the Profile of Mood States (POMS) at baseline, at the end of the adjunctive phase (week 19) and the monotherapy phase (week 36).

The NDDI-E is a 6-item self-reporting instrument that has been validated against the Structured Clinical Interview for DSAM-IV axis I disorders with scores of 15 or more indicating moderate to severe depression. The inventory has also been shown to have convergent validity with the BDI-II.

Overall, 96 patients completed the adjunctive phase, and 66 completed the monotherapy phase.

At the 3 follow-up points, mean scores on the NDDI-E were 13.5, 12.0, and 10.5, respectively; on the BDI-II, mean scores were 17.4, 11.6, and 7.7, respectively; on the CES-D, mean scores were 24.4, 15.4, and 11.5, respectively; on the CDRS-SR, mean scores were 59.8, 53.3, and 48.4, respectively; and the mean total POMS scores were 56.2, 36.8, and 21.6, respectively. All change scores were significant at P <.0001.

While 36% of patients were seizure-free at baseline, 56% were seizure-free after adjunctive therapy and 67% after monotherapy. Dr. Fakhoury said the results corroborate data from an earlier report suggesting that lamotrigine has antidepressant activity in epileptic patients.

The new findings also show the NDDI-E is a valid, simple screening tool and appears to detect the presence of a moderate to severe depression in epileptics.

In epileptic patients, the single most important determinant factor of health-related quality of life is the presence or absence of a depressive disorder, Dr. Fakhoury said.

The study was sponsored by GlaxoSmithKline.


[Presentation title: Lamotrigine in Patients With Epilepsy and Comorbid Depressive Symptoms. Abstract P02.142]

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