Lacosamide in bipolar disorder: A 30‐day comparison to a retrospective control group treated with other antiepileptics

Abstract

Aim Bipolar disorder (BD) is often treated with anticonvulsants. Lacosamide has not been tested in BD. We assessed its effects in a hospital setting in patients with BD without epilepsy. Methods We treated 102 consecutive hospitalized patients with acute BD with lacosamide 50–300 mg/day. We compared this sample with a retrospective sample treated with other antiepileptics (OAE). We rated patients after 3, 7, 15, and 30 days of treatment with the Brief Psychiatric Rating Scale, Young Mania Rating Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Clinical Global Impressions – Severity, and Global Assessment of Functioning. Results Patients receiving lacosamide were significantly younger and had fewer mixed episodes at intake, and less substance use disorder comorbidity than those receiving OAE. Both groups showed positive effects on all measures. The two groups did not differ on any clinical measure at baseline, but from the 3rd day on, lacosamide patients fared better than OAE patients on the Young Mania Rating Scale and Clinical Global Impressions – Severity and worse on the Hamilton Anxiety Rating Scale. From the 15th day, OAE patients scored better on the Brief Psychiatric Rating Scale. Global Assessment of Functioning scores were significantly more improved in the lacosamide patients. Age, substance use disorder comorbidity, episode type, and educational level significantly affected results. No interactions were found amongst these parameters. Conclusion Lacosamide was effective in reducing psychopathology, mania, depression, and anxiety and in improving global functioning in patients with BD‐I/II disorder in the short term, with few side‐effects. Lacosamide improved mania, clinical severity, and global functioning better than OAE at doses lower than those used in epilepsy.

Effects of Lacosamide Treatment on Epileptogenesis, Neuronal Damage and Behavioral Comorbidities in a Rat Model of Temporal Lobe Epilepsy

“…Moreover, LCM managed to alleviate the symptoms of depression in the epileptic animals during the post-SE period and to alleviate epilepsy-induced hyperactivity in the activity cage. Data about the effect of LCM on anxiety levels and depression are very scarce, although experimental as well as clinical studies have recently shown improved symptoms after acute or chronic treatment with this drug in rats and epileptic patients [ 47 , 48 , 49 , 50 ], as well as in patients with bipolar disorder without epilepsy [ 51 ].…”

The therapeutic effects of lacosamide on epilepsy-associated comorbidities

“…Moreover, in patients with partial-onset seizures, the treatment of epilepsy with lacosamide also may improv anxiety, depression as well as quality of life without worsening indicators of sleep quality and fatigue ( 3 , 73 , 74 ). In addition, lacosamide improved mania, anxiety, depression, and global functioning in the short term when used for the treatment of patients with bipolar disorder compared to other ASMs ( 72 ).…”

The antiepileptic drug lacosamide and memory – A preclinial study

“…Especially, first generation of AEDs may cause a deterioration in cognitive functions thus contributing to a significant reduction in the patient's quality of life [9]. Due to mechanism of action and pharmacokinetic properties, there is an opportunity to use LC not just in epilepsy [10][11][12][13]. It is worth emphasizing, that preliminary preclinical results indicate the possibility of using the drug in Alzheimer's disease [14].…”