Long-term efficacy and safety of lamotrigine for all types of bipolar disorder

Abstract

BackgroundWe investigated whether the long-term efficacy and safety of lamotrigine (LTG) for bipolar disorder (BP) differs between disease types (BP-I, BP-II, or BP not otherwise specified [BP-NOS]), and the efficacy of the concomitant use of antidepressants (ADs).MethodsFor >1 year, we observed 445 outpatients with BP (diagnosed by DSM-IV criteria) who initiated LTG treatment between July 1 and October 31, 2011, using the Himorogi Self-rating Depression (HSDS) and Anxiety Scales and the Clinical Global Impression-Improvement scale and also recorded adverse events.ResultsTreatment efficacy was observed at week 4, with the improved HSDS scores sustained until week 52 for all types of BP; 50% of the patients with any type of BP could be treated with LTG for 1 year, whereas ~40% could be treated for >1.5 years. However, 25% of the patients were withdrawn within the first 4 weeks. The overall incidence of adverse events was 22.9% (104/455): 34.1% (14/41) for BP-I, 22.7% (15/66) for BP-II, and 22.2% (75/338) for BP-NOS. The most common adverse event was skin rash: 22.0% for BP-I, 16.7% for BP-II, and 12.1% for BP-NOS.LimitationsThere was no control group. Data were collected retrospectively.ConclusionWith careful and adequate titration, long-term treatment with LTG is possible for any type of BP, with BP-NOS patients, the largest population in clinical practice, responding particularly well. Symptoms can improve with or without ADs. Large-scale prospective studies of the efficacy of ADs in bipolar treatment are warranted.

A pilot open series of lamotrigine in DBT-treated eating disorders characterized by significant affective dysregulation and poor impulse control

“…As noted previously, lamotrigine is utilized in other conditions characterized by dysregulated mood and poor impulse control, including bipolar disorder and BPD. When used in bipolar disorder, it is most notably effective in reducing depressive symptoms [29]. This ability to stabilize mood with potentially greater impact on depression [55–57] may account for our exploratory and very preliminary findings of moderate reductions in depressive symptoms for some eating-disordered patients.…”

“…One such medication is lamotrigine, an antiepileptic drug. It has received FDA indication [28] for maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes, and it is used widely for bipolar II disorder and unspecified bipolar and related disorders [29]. Lamotrigine also has shown promise in the treatment of borderline personality disorder (BPD) [30, 31].…”

The Staging of Major Mood Disorders: Clinical and Neurobiological Correlates

“…Lithium nonresponsive conditions are chronic disorders that better respond to atypical neuroleptics, and have similarities to psychotic spectrum disorders [ 14 ]. Contrarily, some bipolar spectrum patients preferentially respond to anticonvulsants, as is the case with BD type II patients with comorbid anxiety disorders [ 15 ]. BD with psychotic symptoms has overlapping neurobiological findings with schizophrenia spectrum disorders, and such patients present with a higher risk of having family members with chronic, non-affective psychoses [ 16 ].…”

Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review

“…A Japanese observational study 56 reported findings for 445 patients with BD-I, BD-II or BD not otherwise specified (BD-NOS) who received LTG for 12 months (or until withdrawal), in most cases (77.5%), to supplement existing medication. Outcome measures were the Himorogi Self-Rating Depression Scale (HSDS), Himorogi Self-Rating Anxiety Scale and CGI-I.…”